Arline MacCormack has had four primary care physicians in the past four years.

MacCormack, a college administrator and longtime Newton resident, saw the same “fabulous” doctor through Newton-Wellesley Physicians Primary Care for over two decades. Four years ago, her doctor suddenly retired and told her that she was frustrated with the health care system.

After searching for over a year—without assistance from her former physician’s office—MacCormack found a new doctor and made an appointment. At her first visit, the doctor told her that she would soon be leaving her practice.

MacCormack then switched to another doctor within that practice, but was notified that the doctor was leaving before she even had her first appointment. Again, after one visit and a prescription refill, MacCormack was left to find her fourth primary care physician in four years. She now sees a physician assistant at Wellesley Family Care and does not have trouble getting appointments.

“I’m happy now, but it was a scary three years. Bigger picture, health care in our country is very broken, and we need to learn from others who are doing it better,” said MacCormack.

She is not alone in her struggle to find stable primary care. Primary care services are facing difficulties across the United States. In Massachusetts, trends show that the number of primary care physicians in the commonwealth is shrinking, with employment in physician offices barely increasing since pre-pandemic levels, lagging far behind overall national trends, according to the Massachusetts Health Policy Commission.

The HPC also said that Massachusetts has one of the smallest proportions of its physicians specializing in primary care, and of new doctors entering primary care following their residencies. The shortage of doctors, coupled with a growing population, has created more difficulties in accessing care.

“We know that access to primary care improves health outcomes, reduces health disparities, and ultimately can help avoid unnecessary emergency department and hospital use. Yet despite this overwhelming evidence, support and investment in primary care is declining and represents a shrinking portion of our health care dollar,” HPC Executive Director and Primary Care Task Force Co-Chair David Seltz said in a statement.

Jessica Benjamin, a Newton resident, said that only seeing her primary care physician once a year has led to a lack of continuity in her health care.

She first entered the Mass General Brigham health care system in 2017 when she began seeing a new doctor. When that doctor moved away in 2022, Benjamin was reassigned to another doctor within the system, and since then she has only been able to see that doctor for an annual checkup. For anything else, she has been assigned to another doctor, nurse practitioner or sent to urgent care.

Over the past few years, Benjamin has been treated for chronic pain. In November 2024, she made an appointment with a doctor she had never met before and they prescribed her a muscle relaxant called Robaxin – but never told her about possible side effects.

In May, Benjamin fainted and broke her ankle. Later, she learned that fainting is a known side effect of Robaxin. The injury was a displaced fracture that required surgery, followed by months of recovery. She couldn’t put weight on her foot until July and started physical therapy in September. Because she was out of work for so long, she was ultimately separated from her job.

“You’re seeing all these different people who don’t know you and your history, and I think that contributed to me breaking my ankle,” said Benjamin. “I used to be able to call my doctor and she knew about my various issues, which is just a lot easier than going to see a new person every time.”

The Primary Care Access, Delivery, and Payment Task Force was established in January by Gov. Maura Healey to develop recommendations to stabilize and strengthen the primary care system across Massachusetts, including a primary care spending target. Since their first meeting in April, the task force has completed its first deliverable to define primary care services, codes and providers.

A study on primary care appointment availability discovered that out of four states, Massachusetts wait times were more than twice as long as in the other states.

In 2023, 91% of Massachusetts residents reported having a primary care physician, but 41% of those residents said they had difficulty accessing care because they couldn’t get an appointment at a doctor’s office or clinic when needed, according to a survey by the Massachusetts Center for Health Information and Analysis The HPC’s research found that two main factors largely contribute to the shortage: primary care is a low-reimbursed medical field and there is a high administrative burden. Without higher pay, new medical graduates are less incentivized to enter the specialty and may run into financial limits for hiring or retaining support staff. High volumes of administrative work can lead to burnout and contribute to caregivers’ reduction in patient hours.

As the Massachusetts Legislature’s only primary care doctor and physician, Newton Democratic Rep. Greg Schwartz said he brings a new perspective to health policy discussions.

“I’ve seen increasing demands on providers to do the busy work of prior-authorizations, computerized documentation, and elaborate billing,” said Schwartz. “All of this takes time away from directly interacting with patients and face-to-face care.”

Schwartz said that currently 6-7% of all health expenditures in Massachusetts are spent on primary care, and that the remaining 93-94% is spent on specialty care. Schwartz has sponsored a bill to rebalance the system by increasing the proportion spent on primary care to 12% in the next four years.

“If we can increase the amount of growth in resources going into primary care, through higher reimbursements for primary care services, we can increase support for the providers in the trenches,” said Schwartz.

Alan Sager, professor at the Boston University School of Public Health, said that part of what’s driving the shortage is that it’s no one’s job to make sure there is enough primary care in the United States.

“It’s not the job of the federal or state government, medical schools, teaching hospitals or anyone else to make sure we have enough family doctors,” said Sager. To combat the shortage, Sager suggested three possible solutions: draft physicians into primary care; pay them more; or improve working conditions. Regardless of the method used, Sager said that people with political and financial power need to be designated and held accountable for training, organizing, locating and paying enough doctors to go into the field.

As a short-term solution, Sager said that experienced nurse practitioners can handle monitoring patients, but it would be helpful to have an on-site doctor to consult with if anything goes wrong.

“Primary care is like the weather,” said Sager. “Everybody talks about it, but nobody does anything about it.”

Sager said that the problem is only worsening, which he believes isn’t acceptable considering the United States spends six times as much on health care as it spends on defense. He said that a lot of the money is wasted on low-value care, administrative waste, high prices for drugs and devices, CEO salaries and theft. While Sager is optimistic that coordinated changes within the system can be made, he said that it will probably take a crisis to “give us health care that’s as good as our caregivers.”

“Primary care isn’t just about finding a doctor who will see you when you’re sick, it’s about building a long-term relationship of trust, and you can have confidence that they know you and care about you,” said Sager.

Mass General Brigham said in a statement that they are taking steps to address the primary care shortage across the commonwealth and country, by expanding access to care and reducing physician burden.

In May, they announced a nearly $400 million commitment over five years to invest in additional support staff positions for primary care teams, AI tools to streamline clinical visit notes and new partnerships to improve primary care physicians.

“We’re using feedback from our clinicians to ensure we’re improving every day on our mission–providing the best quality care for our patients,” MGB said in a statement.

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This story is part of a partnership between the Newton Beacon and the Boston University Statehouse Program.