This alarming report by Jessica Bartlett published in The Boston Globe highlights the growing primary care crisis in Massachusetts. In short, this foundational element of our healthcare system is on the brink of collapse. The report underscores critical issues: a dwindling Primary Care workforce, poor access for patients, and a system that fails to incentivize the very care that keeps people healthier and reduces overall healthcare costs. Despite Massachusetts boasting some of the most prestigious physicians and healthcare institutions, primary care remains undervalued and overburdened, leaving both patients and providers in unsustainable conditions. The focus on short-term fixes, reactive care, and misaligned incentives has left employers and employees to bear the brunt of skyrocketing costs and diminishing returns. Without bold and strategic action, this broken system will continue to harm employers’ bottom lines, employee well-being, and community health outcomes.

Employers need to meet this crisis head-on and the time to act is now. Delay could be very costly. Employers who embrace proactive, strategic healthcare purchasing—led by a dedicated partner with deep expertise on acquiring advanced primary care services for employees—have the opportunity to walk away from this broken system and embrace one that delivers more value for their organizations and their people. In short this article is a stark reminder of the consequences of inaction. It’s also a call to action for leaders to take ownership of their healthcare strategy and work toward building a system that aligns incentives, strengthens primary care, and delivers long-term value. The status quo can't fix this problem - they created it. 

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Despite Massachusetts having many of the most sought-after physicians in the world, the most basic form of medical practice, primary care, is badly broken here for both patients and providers, state officials said in an alarming new report this week.

Among the problems singled out by the Health Policy Commission in its report Thursday: higher numbers of patients reporting difficulty accessing primary care; an aging and increasingly dissatisfied physician workforce; and an anemic pipeline of new clinicians.

“I worry when I look at some of this data that the state of primary care has crossed a line from which recovery will be very difficult, unless we take action soon,’’ the commission’s executive director, David Seltz, said in an interview.

Patients are feeling the strain. Ann Rogers-Brigham said she called a large health care system four times for an appointment with a new primary care doctor close to her work in Methuen, but struggled to find one in a convenient location or with waits shorter than a year.

She finally found a provider this month and scheduled a wellness visit — in September.

She added that she’s also been told she may get into primary care sooner if she were ill and got a referral from an urgent care center. “It’s almost like you have to be really sick and have a problem to get in,’’ Rogers-Brigham said.

Under a new health care law, a 25-member primary care task force is charged with reviewing reimbursement and recruitments within the workforce, and establishing a target for how much insurers should spend on primary care.

Such goals would put Massachusetts more in line with other states, including California, Oregon, Rhode Island, and Washington, which have set benchmarks for primary care spending. Seltz called such efforts an important way to rebalance incentives in the market.

“This is an opportunity to shift the dialogue, to one of: ‘What can we do immediately to relieve this deep challenge?’’’ Seltz said.

While the commission’s findings could set the stage for changes, they are perhaps not a surprise. Previous reports on primary care have been blaring the same warning signal for years. Increasingly high portions of residents have said they had difficulty accessing health care, while analysis of health care spending has shown less and less is being spent on primary care.

But the report lays out in stark terms just how dire the prognosis is.

Among the findings:

■ Access to primary care is bad and getting worse. New patients wait an average of 40 days in Boston, twice as long as the average of 15 other cities studied. And it’s gotten worse everywhere in Massachusetts in recent years and is especially pronounced in lower-income communities.

■ The lack of access means more reliance on emergency departments, which are expensive places to get care. In 2023, a whopping two-thirds of those who sought care in hospitals’ emergency departments said they were there because they couldn’t get an appointment in a doctor’s office or clinic.

■ An imbalance within the profession. While Massachusetts has the highest number of physicians per capita in the country, the vast majority are specialists. Among just primary care physicians, Massachusetts has the fifth lowest share of primary care physicians.

■ The primary care workforce is aging, with an estimated half of physicians over the age of 55.

■ The pipeline for new primary care doctors is running dry, with only one in seven new Massachusetts physicians in 2021 going into primary care — among the lowest share in the country.

One big driver is the low reimbursement rates for primary care compared to other specialties and hospital services, the state commission said, which discourages both new graduates from entering the field and the health care industry from investing in it.

Beyond the low pay, primary care can be an exhausting job, requiring myriad billing and administrative tasks, increased documentation requirements, and overbooked schedules that undermine the core principal of primary care — caring for the patient.

Dr. Alecia McGregor, a commissioner and an assistant professor at the Harvard T.H. Chan School of Public Health, noted the state is seeing evidence of that burnout and corporatization of medicine, with both those complaints cited as key reasons primary care doctors at Mass General Brigham recently filed to unionize.

Dr. Michael L. Barnett, a primary care physician at Brigham and Women’s Hospital, said patient care involves many aspects that are unpaid and underappreciated. For example, Barnett, who also teaches at the Chan school, estimated about 40 percent of his patients have uncontrolled high blood pressure, necessitating multiple follow-ups just to provide the necessary care.

“What it means is I’m never off,’’ said Barnett, who is involved with unionization efforts at the hospital. “As a primary care doctor, there are always needs that pop up that could require potentially hours of attention to sort out. I’ve been able to juggle it ... but it reaches a breaking point.’’

The state is currently making up for primary care physician shortages by turning to more nurse practitioners and physician assistants, together known as “advanced practice providers.’’ However, even here the numbers of providers working in primary care are dropping, in part because of the low pay.

“Relying on advanced practice providers to serve as (primary care providers) instead of physicians may not resolve challenges related to the availability of providers if we can’t improve job sustainability in the field of primary care,’’ said Sasha Albert, associate director of research and cost trends at the Health Policy Commission, during a presentation at Thursday’s commission meeting.

Dr. Zoe Tseng, an internist at Brigham and Women’s Hospital who is also involved in the union effort, noted that advance practice providers as well are unwilling to work in the very conditions prompting physicians to flee from the field. In many ways, those providers can more easily leave primary care for other specialties.

“Whoever higher up is saying advance practice providers will be the future of primary care, it’s a lie,’’ Tseng said. “They are running just as fast from this specialty. We cannot rely on that potential future. We have to make our working conditions better for everyone.’’

Beyond setting the stage for a new task force, Commissioner Tim Foley said the “scary’’ report emphasized the importance of the commission remaining focused on recruitment and retention.

“It just highlights again our need to continue to focus on the workforce issues,’’ said Foley, who is also the head of union 1199SEIU, which represents health care workers. “We had the hearing on the impact of the workforce, and it hasn’t gotten any better. It’s probably gotten worse.’’

Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.

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