Primary care, the foundation of the state’s health care industry, is crumbling, and Massachusetts is running out of time to fix it, according to a report published Thursday by the state’s Health Policy Commission, which sounded the alarm on many ways the front door to the health care industry is broken.
Among the problems: high and growing rates of residents 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.
The report sets the stage for the work of a new state-appointed primary care task force, created by a health care law signed earlier this month. The law outlines that the new 25-member group will consider issuing recommendations related to increasing recruitment and retention of the primary care 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 the incentives of 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 findings set the stage for reform, they are perhaps not a surprise. Previous reports on primary care have been blaring the warning signal for years. Increasingly high portions of residents have said they had difficulty accessing health care. Analysis on health care spending has shown dwindling amounts of health care dollars going to primary care.
But the report lays out in stark terms just how dire the prognosis on primary care is.
Among the findings:
- Patients’ ability to access primary care is bad and getting worse. New patients must wait an average of 40 days in Boston, twice as long as the average of 15 other cities studied. Access to primary care worsened across the state in recent years, with such issues especially pronounced in lower-income communities.
- A lack of primary care access means more reliance on emergency departments, which are more costly 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.
- Massachusetts has a lot of doctors — the highest total physicians per capita in the country. However the vast majority of those physicians are specialists. Compared to other states, Massachusetts has the fifth lowest share of primary care physicians.
- The primary care workforce is aging, with an estimated half of primary care physicians over the age of 55.
- The pipeline for new primary care doctors is dwindling, with only one in seven new Massachusetts physicians in 2021 going into primary care — among the lowest share in the country.
A primary driver of the current challenge is related to the low reimbursement rates primary care receives relative to other specialties and hospital services, the report states, a factor that disincentivizes 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 visits too short to accommodate the core point 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 very burnout and corporatization of medicine, with both those complaints cited as key reasons primary care doctors at Mass General Brigham recently filed to unionize.
The state is currently making up for primary care physician shortages by leaning more on nurse practitioners and physician assistants, together known as “advanced practice providers.” However the share of even those providers working in primary care is 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.
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 drivers of the recruitment and retention challenges.
“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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