Months-long waits accessing care leave patients sicker and in anguish

A fourth of Massachusetts doctors plan to leave the field in the next two years, according to a survey.

Eric Doty petted his dog Eddie as they stopped during a walk through Boston Common.Jessica Rinaldi/Globe Staff

Suicidal and in pain, Eric Doty had been waiting almost five months for this day, when he could finally get in to see his new primary care doctor at Fenway Health. His former Mass General Brigham provider, whom Doty had seen only twice, had left almost a year earlier without referring him to anyone.

This meeting, in September 2022, would hopefully connect Doty with a new doctor and would also allow him to access therapy services, which Fenway would only schedule if Doty had a regular provider at the clinic.

“I went through my whole medical history,” Doty recalled. “At the end of the meeting, my doctor said, ‘Just so you know, I won’t be seeing you again, because I’m leaving the practice.’ She didn’t like primary care medicine.”

It wasn’t until two months later that Fenway Health ultimately cleared him for therapy services — and even then, it said he’d have to wait another six to eight months.

By most measures, many Massachusetts residents are finding it increasingly difficult to get appointments with doctors. In 2021, a third of patients in the state said they struggled to obtain necessary health care — a narrow increase over 2019 levels.

That shortage is taking a toll on patients. Many detail worsening health problems and expensive trips to emergency rooms. Some parents have had so much trouble finding pediatricians that they have been unable to enroll children in school or day care, since schools require health forms that must be signed by providers.

Studies have unveiled a particular challenge within primary care. In Massachusetts, the rate of doctors leaving the field exceeds the national average and about one-third of primary care physicians are over the age of 60. Not enough young people are entering the field to take over for those who retire, due in part to lower salaries and insurance reimbursements compared with other specialties.

According to a 2021 National Academies of Sciences, Engineering, and Medicine report, 18.6 percent of adults in Massachusetts lacked a usual source of health care in 2020, up from 10.8 in 2015. For children, access also dipped. In 2015, just 0.9 percent of children in Massachusetts reported not having a usual source of health care; by 2020, that number had risen to 6.9 percent.

The problem has grown so acute, that patients calling the primary care referral line for Mass General Brigham — the state’s largest health system — are being told there are no openings at their Boston hospitals.

Health care providers acknowledge the difficulties. Fenway Health chief executive Ellen LaPointe said she was unhappy with the long waits for primary and behavioral health care, which she attributed to a shortage of clinicians as well as high demand.

“There is no easy solution to this problem,” she said in an e-mailed statement. “In the short-term, we are working on ways to help our patients secure other options to access care, including helping them transfer their care to other providers if they wish. ... But even this has been difficult to achieve, because other providers of medical and behavioral healthcare are in the same boat — meaning that they also don’t have enough clinicians to meet the demand.”

The problems are only expected to worsen. According to a 2021 report by the Association of American Medical Colleges, there will be a shortage of between 17,800 and 48,000 primary care physicians nationally by 2034, and a shortage of between 21,000 and 77,100 physicians in nonprimary care specialties. In Massachusetts alone, a fourth of doctors say they will leave the field in the next two years, according to a recent survey of its members by the Massachusetts Medical Society.

Experts say primary care serves an important triage function that prevents people from seeking care at more expensive places, and it is critical to start there with solutions.

“Every time primary care isn’t able to do what they are supposed to do, there is more demand on everybody else,” said Barbra Rabson, chief executive of Massachusetts Health Quality Partners, a nonprofit working to improve patients’ experiences.

Larry Cohen, 72, had called his primary care doctor at Harvard Vanguard after he was knocked unconscious by a wave on vacation in St. Martin in January. He had hoped to visit with his doctor as soon as he returned to follow up on lingering head and neck pain. But the practice only offered Cohen an appointment with a nurse practitioner that was days after he would get back. He tried messaging his doctor directly, but the note was intercepted by medical staff.

Then, on his way home, Cohen received an urgent call from his doctor’s office. “You could have a brain bleed and die any minute,” they told him, and said he should go to the emergency room.

Ultimately Cohen went to an urgent care center at Lahey Health. A CAT scan came back clear, but the experience stayed with him. He was thinking about looking for a new doctor but wasn’t sure if he would experience similar access issues with another doctor, if he could even find one.

“As much as I like this doctor, I’m disappointed in their response and how it was handled,” Cohen said. “But that begs the question — [can you find] a primary physician you like if you’re going to switch? Most of the doctors are not taking new patients.”

Finding a new doctor can itself be a months-long process, made even more difficult for patients who are immigrants and don’t speak English. Angela, who asked that her last name be withheld to protect her privacy, found a job and a day care for her then-3-year-old daughter after immigrating from Brazil in 2022. But the day care wouldn’t let her daughter attend until she had been to a pediatrician.

Angela does not speak English and said through a translator that she tried for months to call pediatricians recommended to her by the school. Unable to understand her, offices would put her on hold and disconnect her. One refused to see her daughter because of Angela’s MassHealth insurance; another declined because Angela didn’t have historical medical records for her daughter.

Ultimately, Angela connected with consumer advocacy organization Health Care For All, which helped her find a pediatrician and scheduled an appointment in July. She cried the whole day after getting the appointment, a mix of relief and exhaustion, Angela said.

But the four-month process took so long she lost the prospective job and the full-time day care spot. Angela now has her daughter enrolled in a partial-day preschool program and has to pay for a babysitter for the half day of child care. She found a different job cleaning, but she earns less than she otherwise would have.

Angela said she has given up trying to find a doctor for her 19-year-old son, herself, and her husband, who has back issues that sometimes affect his ability to work.

Some have been able to find appointments only with the help of other doctors. Emily Chambers, 37, of Stoughton, said her cardiologist got her an appointment with a pulmonary specialist, who otherwise had a months-long wait, for the pain, shortness of breath, and fatigue she’s had for two years.

Meanwhile, Doty, who is still waiting to see a therapist at Fenway Health, had a new health crisis. In March, he began experiencing severe neck pain and losing sensation in his arms and legs. Unable to find a neurological specialist, he called Fenway Health, and a week later, got in to see a nurse practitioner. The clinician scheduled him for an MRI in several days. But two days later, in severe pain, Doty went to the Mass. General Hospital emergency department. The ER, in turn, recommended Doty see a neurological specialist.

Doty said he has leaned on friends and family to get through his health challenges. One can survive “if [they] can find the strength within themselves to keep living,” he said. “Because there are no resources right now.”