If you’re having trouble getting an appointment with your primary care doctor, you’re not alone. These days, my conversations with friends often shift from comparing knee replacements to commiserating about the long wait times to see a physician—or the struggle to find one at all.

Earlier this year, the Massachusetts Health Policy Commission, an independent state agency, released a sobering report titled “A Dire Diagnosis: The Declining Health of Primary Care in Massachusetts and the Urgent Need for Action.” The findings are alarming: access to primary care is worsening, physicians are aging and increasingly dissatisfied, and the pipeline of new clinicians is insufficient.

You can access the report here. 

Here’s the paradox: Massachusetts has more doctors per capita than any other state—but most are specialists clustered in academic medical centers. When it comes to primary care, the state ranks near the bottom, with the fifth-lowest proportion of primary care doctors providing direct patient care.

A Matter of Supply and Demand

On the demand side, the issue is straightforward: as the population grows and ages, the need for healthcare—especially primary care—rises. The U.S. population now stands at 342 million, including 58 million people aged 65 and older. By 2030, that number will jump to 72 million. This aging population faces complex, chronic conditions—like type 2 diabetes—that are best managed by primary care providers. Currently, 17 million older adults have type 2 diabetes; that figure is projected to reach 21 million by 2030.

And here in Barnstable County, the demographic shift is even more dramatic. With more than one-third of residents aged 65 and up, we have the oldest population in the state—and that percentage is expected to keep rising. The strain on our local healthcare system will only intensify.

The Shrinking PCP Supply

On the supply side, things get more complicated. The number of primary care physicians (PCPs) actively practicing in clinical settings isn’t keeping pace with the demand. Why?

Several factors are at play: an aging physician workforce, widespread burnout, fewer medical students choosing primary care, and increasing corporate ownership of practices. There’s also a rise in alternative models like concierge and virtual care. And looming over it all are financial pressures—especially the crushing burden of medical school debt and the relatively low compensation for primary care physicians.

More than one-third of Massachusetts’ primary care physicians working in office settings are age 60 or older. As they retire, they’re not being replaced fast enough. Only 22% of Massachusetts medical school graduates choose primary care residency programs—among the lowest rates in the country. With average medical school debt now topping $220,000, young doctors are gravitating toward higher-paying specialties. A family medicine doctor earns about $200,000 annually. Compare that to $400,000 for a dermatologist or $750,000 for a neurosurgeon.

I graduated from the University of Chicago’s Pritzker School of Medicine in 1966. My total tuition for four years was $10,200—about $101,000 in today’s dollars. The class of 2024 is dealing with costs totaling $368,000.

And once they’re in practice, primary care physicians face mounting administrative burdens. The following quote sums up how many physicians in an office practice are feeling, beyond the low pay, primary care can be an exhausting job, requiring myriad billing and administrative tasks, increased documentation requirements, and overbooked schedules that undermine the core principal of primary care— caring for the patient.

Physician Burnout

In a recent survey of nearly 21,000 Massachusetts physicians, 55% reported feeling burnout. More troubling, 27% said they planned to leave medicine within a few years.

The top reasons? Too many bureaucratic tasks, too many hours at work, lack of respect from administrators and specialist colleagues, insufficient compensation, loss of autonomy, using electric health records, and dealing with insurance companies, especially managing prior authorizations and denied claims.

In addition, physicians are dealing with corporate takeover of their practices. Currently 78% of physicians work for corporate entities—55% for health systems and hospitals, and 23% for for-profit entities such as private equity groups, insurance companies and large retail pharmacy chains. In reaction to the burdens and ethical concerns caused by these arrangements, physicians are retiring early, leaving clinical practice, shifting to non-patient positions such as teaching and research, forming unions, and working in concierge and telehealth practices.

NPs and PAs: Filling the Gap

To help offset the PCP shortage, many healthcare systems are increasingly relying on nurse practitioners (NPs) and physician assistants (PAs). These highly skilled professionals are trained to diagnose, treat, and manage many of the same conditions as doctors. In Massachusetts, NPs can now practice independently, without physician oversight, a policy change aimed at expanding access to care.

Both professions have seen rapid growth in recent years and are playing an essential role in filling the void left by departing or retiring doctors. In an ideal system, these providers work together in team-based care models that improve access, outcomes, and patient satisfaction.

What’s Next?

The shortage of primary care doctors is not just a scheduling inconvenience—it’s a growing public health crisis. Primary care is the foundation of a strong healthcare system, helping patients stay healthy, managing chronic illness, and avoiding costly emergency care. Without bold action—from expanding training programs and loan forgiveness, to supporting team-based care models and rethinking reimbursement—this crisis will only deepen. If we don’t invest in the future of primary care, we may all be asking the same question for years to come: Where have all the doctors gone?

A Personal Note

This is a complicated subject and a single article cannot do justice to the complexities of the deterioration of our healthcare system. It is very frustrating when you cannot get an appointment to see a healthcare provider. But the problem is not your doctors, they didn’t sign up to fight with insurance companies or spend half their day in front of a screen. They signed up to care for people. It’s the system that’s broken.