Slots for primary-care training, including family medicine, pediatrics, and internal medicine, also increased by 877 positions this year, offering up to 20,300 positions for the nation. This seems like promising news for a city like Boston, where the wait for a new patient to access primary care is at least 40 days, twice as long as in 15 other studied cities, and up to half of the primary-care workforce is close to retiring age. The most recent primary-care dashboard from Massachusetts Health Quality Partners, a measurement and reporting nonprofit organization, shows that these shortages are driving up visits to emergency departments, spiking Massachusetts’ total cost on health care, and disproportionately affecting low-income people and people of color, further aggravating our state’s health inequities.

The small increase in slots to train future primary-care physicians nationally will not come close to fixing our primary-care crisis in Massachusetts, however. In a state that has more physicians per capita than any other in the United States, only 22 percent of Massachusetts medical school graduates were providing primary care six to eight years later, as of 2023.

Further, not all primary-care training programs are equal in terms of generating practicing primary-care physicians. According to a recent study, 97 percent of family-medicine residents conclude their training in primary care, whereas only 54 percent of pediatric residents and 35 percent of internal medicine residents conclude their training in primary care. In other words, the vast majority of new primary-care physicians in the United States are family-medicine physicians. Given the robust training of family-medicine physicians, including caring for prenatal, postpartum, pediatric, adult, and geriatric patients, this workforce is crucial.

However, while 13.4 percent of first-year residency positions were in family medicine nationally, Massachusetts only provides 3.9 percent of its first-year residency slots in family medicine. Given that studies show the vast majority (68.7 percent) of family-medicine graduates continue to work in the state where they trained after graduation, this anemic number is a poor harbinger for our future.

A significant barrier to training more family-medicine physicians is the lack of academic medical support. Apart from Boston Medical Center, there are no family-medicine departments in Boston’s academic medical centers, where the majority of graduate medical education occurs. The rationale often cited is that it is the responsibility of community-based institutions to train future primary-care and family-medicine doctors. However, it is exceedingly difficult for community-based hospitals and community health centers to take on this responsibility with already tight profit margins, a lack of internal infrastructure to support residency programs, and traditional residency program funding flowing to academic medical centers.

If Massachusetts wants to have adequate access to primary-care physicians, it needs to prioritize and organize state-level partnerships between large academic institutions and community-based institutions, particularly community health centers, to develop infrastructure and funding for new family-medicine residency programs. Academic medical centers must include investments in developing family medicine as part of their larger primary-care investment plans. Legislators must also reinstitute Medicaid Graduate Medical Education funding in Massachusetts that is targeted to support family-medicine training programs. Currently, Massachusetts is one of only seven states that does not fund residency programs through this program.

Furthermore, to attract more motivated and capable medical students to enter the field of family medicine, health care leaders, educators, and policy makers must work to make the job more sustainable. This includes actions such as statewide policies increasing reimbursements for family-medicine services from all payers, streamlining the number of health care metrics family-medicine physicians are accountable for, and reducing the administrative burden of family-medicine physicians by accelerating the use of AI to complete forms for items such as durable medical equipment, prior authorizations, and messages generated through electronic medical systems.

We are grateful to Governor Maura Healey for her recent remarks on prioritizing primary care; to the Legislature for the development of the Primary Care Task Force, which will focus on primary care access, delivery, and financial sustainability; and to the recent Massachusetts legislative hearings on Senator Cindy Friedman’s Primary Care for You bill. However, we cannot wait for the group’s recommendations to start addressing our state’s primary-care crisis. Legislators, payers, hospitals, and community health centers must work now to strengthen and grow the family-medicine workforce, build a stronger pipeline, and pay for a health care system that will build a healthier Commonwealth.