WILLIAMSBURG — Over the period of a single year, Osa and Christopher Flory found themselves cycling through three different primary care physicians.

After their longtime doctor retired, the Williamsburg couple found another Cooley Dickinson Hospital primary care doctor. But after that physician left to work at the hospital, the Florys were severely limited in finding a new doctor. Scrambling, the couple managed to find a new primary care physician at Valley Medical Group — and not a moment too soon.

In June, Valley Medical Group, the Greenfield-based group that has offices throughout the Pioneer Valley, sent out an email to its patients saying it would be, for the time being, limiting new patients for current doctors to be able to sufficiently serve their current workload.

“While it goes against our mission of community care, for the time being we’ve limited new patient appointments to meet current needs as we work to hire more practitioners,” the email states. “We never want to turn away patients but it’s necessary to serve those who already are scheduled. Once our open provider positions have been filled, we will again offer more new patient appointments.”

For Christopher Flory, himself a retired former primary care physician (PCP), the hassle in finding a physician is emblematic of a much larger crisis that continues to affect the Pioneer Valley and beyond.

“PCPs, to me, are the cornerstone of medicine, and should be,” he said. “Otherwise, people go directly to specialists and that’s much more expensive. It is a real crisis, and it was predictable that this would happen.”

Though the shortage in Massachusetts is certainly not a new phenomenon — reports of a primary care doctor shortage started grabbing headlines almost 20 years ago — it has led experts to ratchet up calls for solutions.

“The dearth of primary care physicians in Massachusetts is no longer a looming public health threat,” Dr. Barbara S. Spivak, past president of the Massachusetts Medical Society, said in a statement last fall shortly after the state’s largest hospital system announced it could not accept new primary care patients at its Boston practices because of a mounting workforce shortage. “It is here and represents a major public health crisis that requires urgent and sustainable financial investment and actions aimed at recruiting and retaining primary care physicians.”

According to figures from the state’s Center for Health Information and Analysis, more than 41% of residents reported difficulty in obtaining necessary health care last year, a more than 10% increase from 2021. It also stated that a larger percentage of physicians were leaving primary care than in recent years, while only 22% of the state’s medical school graduates were practicing primary care six to eight years after graduation. It also showed that the percentage of primary care physicians in the state was decreasing, while the number of PCPs aged 60 or older was increasing.

Medical professionals and practicing primary care doctors who spoke to the Daily Hampshire Gazette described a current climate of increasing administrative burden for doctors, a medical school system where aspiring PCPs face a mountain of debt upon graduation and an aging population that leads to problems for both the workforce and patient care that results in a worsening situation for the primary care field.

Paul Carlan, president and CEO for Valley Medical Group, said there are also unique challenges for recruiting new doctors for the Pioneer Valley, which is a more rural area and away from most major medical schools.

“There is certainly a difference in how well paid providers are in terms of salaries in the western part of the state,” Carlan said. “Training programs tend to be in cities, folks get trained in an urban environment, they’re more comfortable practicing there, they have lives established in the cities. So I think it’s harder sometimes to attract folks to rural communities.”

Carlan said Valley Medical Group is working to hire more physicians so that it can continue to be able to take new patients and better provide for the communities it services. The group has offices in Greenfield, Northampton, Easthampton and Amherst.

“We’ve taken our responsibility to the community very, very seriously,” Carlan said. “We’re really looking for solutions that involve expanding our workforce and changing how we’re working so that we can expand access to new patients as soon as possible.”

Challenges affecting PCPs

Recent data also helps illustrate just how acute the situation physicians in the state face. According to a report by the Massachusetts Medical Society, a fourth of doctors in the state surveyed said they were considering leaving the field in the next two years. More than half of respondents said they were experiencing burnout, and only one in three physicians said they felt their work schedule allowed them enough time for their personal and family life.

Hugh Taylor, a practicing physician who serves as president of the Massachusetts Medical Society, said that since 1982, when he first started his career, he has seen a much larger increase in the amount of prior authorization required from physicians by insurance companies, adding to the amount of paperwork doctors must complete for patients.

“We’re providing the care we want to provide, but we have to add a couple of extra steps to do it,” Taylor said. “The other thing is that we are doing, frankly, more psychiatric care now than we used to. It may be that people are having a hard time finding counselors, social workers, therapists. That’s been an interesting change. We’ve been prescribing antidepressants, for instance, on a more frequent basis.”

Carlan, who also continues to practice medicine while serving as Valley Medical Group’s president and CEO, agreed with the added administrative burden over the years, saying that prior authorization is now needed even for well-known and proven effective drugs for treatment of common conditions such as diabetes and attention deficit hyperactivity disorder (ADHD).

“Everyone agrees for the standard of care for treatment of diabetes, and we spend hours and hours trying to get authorization for these drugs for our patients. It’s a big problem,” Carlan said. “And then there are actually supply issues relating to these medications, too, so that patients are having to switch back and forth between different strengths and brands of drug just because they don’t have them.”

Open spots fill up fast

At medical centers in western Massachusetts under Mass General Brigham ownership, including Cooley Dickinson Hospital, half of the primary care providers are currently accepting new patients, with an average wait time of about four months to get an appointment, according to Dr. Jessica Dacus, a family practitioner at Hadley Family Medicine.

“Our providers that are accepting are filling up pretty quickly, because as elsewhere, spaces are full,” Dacus said. “We’ve been fortunate to have a talent acquisition team supported by MGB that’s really been great for new hires, and that’s why we have the space that we do.”

Dacus, who has been practicing in Hadley since 2009, said like many of her peers, she went into primary care, rather than a more lucrative specialized field, because of her love for caring for patients and their families.

“It’s a privilege and honor to do what we do, and we hang onto our patients for decades,” Dacus said. “It’s an incredibly rewarding and humbling experience, and all of our providers have made that choice consciously over going into a higher paying specialty field.”

But Dacus also agreed the administrative burden for physicians has increased significantly since she first started. One factor that has contributed to that, Dacus said, has been the advent of electronic medical records, meant to provide greater transparency to patients and bring hospitals into the digital age. However, it also means doctors spend more hours of their day looking over messages, notes and patient results on Epic, the medical records system used by Mass General Brigham. Dacus said the average PCP at Mass General spends around two and half hours per day on Epic.

“The amount of time that a primary care physician needs to spend on our administrative work is almost double what the average physician would spend,” Dacus said. “Although it’s a wonderful thing to be 100% transparent, it has placed a huge burden on physicians.”

AI to the rescue?

To try to address the administrative burden of primary care physicians, Mass General Brigham has looked into the possibility of using artificial intelligence to assist doctors in patient messaging. In April, the hospital system released the results of a study of using the GPT-4 large language model for patient messaging, finding that the artificially generated messages were acceptable without any additional editing 58% of the time and provided more detailed information than those written by physicians. On the flip side, 7% of messages were deemed unsafe if left unedited.

“The emergence of AI tools in health has the potential to positively reshape the continuum of care and it is imperative to balance their innovative potential with a commitment to safety and quality,” the hospital stated. “Mass General Brigham is currently leading a pilot integrating generative AI into the electronic health record to draft replies to patient portal messages, testing the technology in a set of ambulatory practices across the health system.”

Dacus said that for her, the use of AI in the doctor’s office provided an opportunity for more face-to-face interaction with patients.

“If I’m in an office with a patient, instead of having my nose in the computer because I’m typing, we can have AI running in the room that is transcribing what the patient’s saying and what I’m saying, which is hugely helpful,” Dacus said. “It really helps us make a better connection with our patients.”

Legislative efforts

At the legislative level, there have been proposed bills in the Massachusetts State House to address the shortage of PCPs in the state. One bill, known as Primary Care for You or PC4You, would require all commercial insurance payers in the commonwealth to offer a prospective, per patient, per month payment to all primary care practices who chose to opt in, with the goal of increasing primary care spending to 12% to 15% of all health care expenditures in the state by the end of the decade. It would also mean patients would not be responsible for co-payments, co-insurance or any deductibles when accessing primary care.

“It would basically remove primary care from insurance payments, and instead it would be paid on a capitation system, where your pay is dependent on your patient population,” Taylor said of the bill. “The bill also has provisions to provide increased reimbursement if physicians do certain things to improve care, such as having evening and night hours, psychiatric or social work, folks embedded in the practice providing extra services.”

Though that bill will not go through this year, having not been included in the Senate’s final budget, there is a provision for the creation of a Primary Care Task Force, to work on the details on how such a future bill might work in practice.

For others, there exists another alternative solution, one that is simpler, if not a little more radical — the introduction of a single-payer health care system, also known as “Medicare for All,” a form of universal health care that has long existed in many other developed nations but has eluded the United States for decades.

Jon Weissman, a Granby resident who chairs the board of Mass-Care, a statewide organization that campaigns for single-payer health care in Massachusetts, said the PC4You bill had limitations in that physicians had to opt in to the program, meaning not all patients would get the benefits included for them in the bill.

“It’s a mixed bag,” Weissman said. “The bill is discriminatory out of necessity, because the strategy is to get money out of the insurance companies. What we say is rather than get the money out of the insurance companies, get the money out of the people who pay the insurance companies, that’s you and me and all of the commonwealth.”

Weissman also said primary care physicians would be more prioritized under a single-payer system.

“It reimburses primary care doctors at a better, higher rate,” Weissman said. “The gateway doctors have got to be valued more, the people you see first, the pediatricians and primary and family physicians. And that’s inherent in our [proposed single-payer] bill.”

For Osa and Christopher Flory, they concur with the idea that a single-payer system is the best solution.

“Medicare for All would have the ability to solve a lot of this because it at least puts somebody in charge of the system and could make some adjustments of reimbursements,” Christopher Flory said. “Various specialties are reimbursed very, very generously, and primary care is not and that could be altered, but somebody would have to be in charge to plan it.”

Alexander MacDougall can be reached at amacdougall@gazettenet.com.