When the phone rings at East Providence Primary Care, chances are there is someone in search of a new doctor on the other end.
It happens up to 15 times a day, but the response is the same: “I’m sorry, we’re not taking new patients right now. Call back in six months.”
It’s become a routine in recent months since the practice reached full capacity. Only one of the six primary care physicians at the Brown Medicine practice is still accepting new patients but with a long wait time of up to eight months. And for those being turned away, it’s just as unlikely that they have any luck with another practice for months – possibly years.
“The world of primary care is in the midst of a big change,” said Dr. Thomas Bledsoe, a general internist and primary care physician at East Providence Primary Care. “[In the past] it seemed like there were always other options for people, but lately it seems to be approaching a crisis.”
Bledsoe, who also serves as president of the Rhode Island Medical Society, says his practice has gone through periods at full capacity before, but in recent years things have gotten worse. Health care professionals say the crisis has been created by experienced primary care doctors leaving medicine while fewer new doctors are entering primary care specialties nationwide.
In Rhode Island, approximately 72% of primary care needs are being met, according to an analysis by the Kaiser Family Foundation using data from the U.S. Department of Health & Human Services. The number is better than the national average of 47%.
It is estimated that the United States could see a shortage of between 37,800 and 124,000 physicians by 2034, according to a 2021 study by the Association of American Medical Colleges.
“It’s a complex problem without a simple cause or solution,” said Dr. Rebekah Gardner, associate professor of medicine at Brown University’s Warren Alpert Medical School. “Many practices in the state are closed to taking new patients because the doctors in those practices are overwhelmed caring for the patients they already have.”
Gardner says burnout is often at the top of the list of reasons driving doctors from the field, something that worsened during the COVID-19 pandemic. A 2018 study led by Gardner found that the increasing use of electronic health records caused higher stress for primary care doctors in particular because it increased the amount of time they spend working on patient files outside of their normal hours, creating what Gardner called a “tsunami of work.”
It’s not just burnout. Primary care is an aging field and recruitment of new doctors has been difficult with other specialties proving more lucrative. Retirements can leave gaps in existing practices that can go unfilled for years. At East Providence Primary Care, Bledsoe says the practice could easily double its size.
And it’s expected that demand for generalists will continue to rise as the population of older people in Rhode Island and across the country continues to grow.
“The real issue is: How do we get folks to choose primary care as a field?” Gardner said.
One of the main obstacles to recruiting new physicians is Rhode Island’s low Medicaid reimbursement rate for primary care, according to health care observers. Compared with the national average and its neighboring states, Rhode Island’s low reimbursement rates can discourage recent medical school graduates – typically carrying hundreds of thousands of dollars in student loan debt – from choosing to enter primary care or driving them to practice outside of the state.
“In general, there is projected to be a decreasing amount of people going into primary care from medical schools,” said Dr. Peter Hollmann, chief medical officer of Brown Medicine. “One of the things is to make sure the education paints a positive picture about people that are generalists.”
How? Creating more opportunities in medical school to expose students to generalists and show them what being a primary care physician is like, Hollmann says. Financial incentives such as loan forgiveness programs are another solution, Gardner says.
The shortage is creating a ripple effect.
Without a primary care doctor to visit for an initial appointment, many people have been forced to turn to urgent care centers and emergency rooms, which have been experiencing overcrowding and longer-than-usual waiting times. Sometimes, patients turn to specialists when specialized care is not needed.
Many times, the lack of a doctor leads people to ignore health problems or delay care as their conditions worsen.
“There’s been a backlog. Many people defer care,” said Corey McCarty, senior vice president and general manager of CCA Health Rhode Island in Providence, a nonprofit focused on serving individuals eligible for Medicare or Medicaid. “That deferred care creates greater risks for things to have progressed to the point where people need more attention.”
Looking toward the future of primary care, Hollmann says he does not think the quality of care is at risk, but the shortage of physicians is here to stay. The key, he says, is getting used to a reality where primary care is performed by a team of both physicians and nonphysicians, such as nurse practitioners.
“It’s not practical to think that you’re going to have all primary care done by physicians,” Hollman said. “You’re going to see a greater use of the team caring for people rather than just physicians.”
Correction: An earlier version of this story gave an incorrect location for CCA Health Rhode Island. It is based in Providence. The update of the story also clarifies the description of the nonprofit.