Massachusetts seeks to address shortage of primary care doctors

Burnout, low pay, and mounting administrative burdens: Massachusetts has a shortage of primary care physicians. Lawmakers have proposed a range of long-term solutions, including increasing spending on primary care, creating a task force and expanding the role of physician assistants.

Although Massachusetts has the highest total physicians per capita, it also has the fifth lowest share of all physicians who work in primary care, according to Massachusetts Health Policy Commission. And as older doctors age out, fewer new physicians are entering the profession.

As a result, residents are struggling with a shortage of local primary care providers, many of whom already have long waiting lists. This leads to excessive and unnecessary emergency room visits and treatable issues being left untreated, according to the HPC. Two out of every five emergency visits could have been treated by a primary care physician if those residents were able to get in, the commission found. State watchdogs have already cautioned that Boston has some of the longest wait times for new patient physicals in the country.

Still, this shortage isn’t exclusive to Massachusetts. It can be traced to a multitude of reasons, including lower pay compared to specialty care, administrative strain and burnout.

“The workload for independent and hospital-employed primary care physicians is increasingly taken up by time-consuming administrative tasks, such as billing, documentation, and prior authorization requests and appeals,” said Sen. Cindy Friedman, D-Arlington, Senate chair of the Committee on Health Care Financing.

A new 25-member task force, initiated by the HPC and led by David Seltz, its executive director, is attempting to address the lack of primary care providers.

The task force, which was sworn in in April, will collaborate with legislators, the Healey administration, advocates and providers. They’ll work to find a consensus on urgently needed policy solutions.

The Primary Care Access, Delivery, and Payment Task Force aims to increase the proportion of spending on primary care and to alleviate the administrative burden on primary care physicians, which has led to burnout and fewer medical students choosing the specialty.

In her State of the Commonwealth speech, Gov. Maura Healey called for additional providers to meet the needs of patients. She made primary care a top priority for her administration, emphasizing the need to strengthen and grow the workforce. 

Access to primary care is a “universal need,” which also makes it a top issue for the committee, Friedman said. She has sponsored the wide-ranging Primary Care For You bill in the last two sessions. The bill would change the primary care payment model, increase spending toward primary care services, and establish a Primary Care Board to improve access and delivery.

It would also require the HPC and the Center for Health Information and Analysis to set a primary care expenditure target of at least 12% by 2030.

Right now, only around 6% to 7% of health care spending is dedicated to primary care, Seltz said, adding it has continued to decrease over the last three years.

“I think people would be surprised to learn how little of what we spend on health care actually goes to primary care, considering that this is often many people’s regular interactions with the health care system,” Seltz said.

For every hour of patient time, these doctors are spending approximately two hours filling out forms, getting prior approvals for insurance companies, and additional administrative duties.

“This is a workforce that is ever-increasingly being asked to do more with less and less time,” Seltz said.

Friedman suggested several other ways Massachusetts could make strides towards improving the shortage of primary care physicians. Like 13 states, it could use Medicaid Graduate Medical Education — funding that supports physician training through residency and fellowship programs — to address workforce needs, expand training capacity, and support initiatives that improve patient care and access.

Late last year, Healey signed an economic development bill that would allow international physicians who live in Massachusetts to work without repeating residency. Also in the works is legislation that would remove supervision requirements for physician assistants who have completed 2,000 clinical hours.

The primary care field is filled with doctors who are aging into retirement. That adds to the pressure of encouraging medical students to go into the field despite its lower pay.

“There is a lot of work that needs to be done to make this profession feel as valued as the studies show it to be, and to make that an attractive profession for students to want to go into,” Seltz said.

Looking forward, Seltz envisions a future primary care system focused on team-based care, with primary care providers supported by other staff members. This could mean expanding the workforce to include other qualified professionals, such as nurse practitioners and physician assistants.

Friedman acknowledges that it will take time to make fundamental changes to the health care system and to shift both funding and physicians’ mindsets towards primary care. 

“Many people, understandably so, want to address the problem now, but we’re unsure what that short-term solution may be,” Friedman said.

But, she said, instead of waiting to find a short-term solution, legislators must act now. 

“So, while we wait, we are also delaying the start to that greater shift that is needed,” she said, “and the longer we wait, the more difficult it will be to eventually get to a point where primary care is truly supported and accessible.”