When Fred Kimball moved to Raymond last June, he never imagined that it would take so long and so much effort to find a new primary care physician. He had moved from Pittston to downsize and be closer to his two daughters.

Initially he wanted to keep his Augusta-area provider but eventually he changed his mind and felt that it was impractical to keep seeing a provider who was more than 45 minutes from his new home, he said. So in January he started searching for a provider closer to Raymond.

To his surprise, it was not as simple to find a new PCP as it was 12 years ago, the last time he searched for a new provider, he said.

“In 12 years we’ve gone from an environment where health care, PCP, specialists were readily available to a point where now because of a myriad of things it’s hard to get somebody,” he said.

For about three months, he said, searching for a new PCP became the retiree’s full-time job. He contacted multiple doctors’ offices, some of which were operated by Central Maine Healthcare and MaineHealth.

He kept getting told the same thing, there were no providers currently accepting new patients but that he could be placed on a waitlist without any timeframe for when he might be seen, he said.

Some offices directed him to a phone line for him to leave his name, number and other information, stating that someone would get back to him to place him on a waitlist, from which he heard no response, he said.

After much perseverance and calling providers directly, in early March he was able to schedule an appointment online, for five weeks out, with a new PCP at Poland Community Health Center, a Central Maine Healthcare-owned practice, he said. When it was all said and done, he was astonished at the amount of effort it took to find a new PCP.

Sun Journal interviews with state health experts and hospital leaders, as well as anecdotal testimonies on social media, indicate Kimball is one of many people who have searched long and hard for a primary care physician. Many appear to be languishing on long hospital lists waiting to be accepted by primary care physicians, and when they are accepted, many say they must wait several months to half a year before they can be seen. Others say they have given up the search altogether, frustrated with the situation and endangering their health.

PROVIDER SHORTAGE

Health experts say a primary care physician is a critical component of good health care, providing early detection, preventive care, chronic disease management, coordination of care with specialists and even help with behavioral health issues. Ultimately, they reduce the need for greater medical intervention and hospitalization later and lower medical spending.

People tend to get better care when it is overseen by a PCP, says Dr. James Jarvis, a Bangor-based PCP who chairs the board of the Maine Medical Association. Not only do PCPs know about a person’s overall health but they are also familiar with the patient’s personal history, he said, which helps doctors care for them better.

“I get to know my patients,” Jarvis said. “I know what their lifestyle is like. I often know what many members of their family are doing and therefore I can actually tailor their care to their individual needs.”

So a shortage of PCPs is not only a frustration for those just looking for a doctor in case they become ill and for regular checkups, but can lower the general health of a community and shifts costs from general spending to critical medical care.

Local and state data on the extent of the PCP shortage is difficult to come by from health experts and hospital officials, but local health officials acknowledge it is a real problem, as do residents recently interviewed.

The Maine Hospital Association and the Maine Medical Association do not have any recent state-specific data about the PCP shortage in Maine, but nationally it is estimated that from 2021-36 there will be a shortage of between 20,200 and 40,400 PCPs, according to data in a report recently issued by the Association of American Medical Colleges.

The report also found that nearly half of the physician workforce is nearing retirement age, with roughly 42% of the workforce aged 55 or older. Meanwhile, by 2036, the population of people 65 and older is expected to grow by 34% and the population of people 75 and older is expected to increase by 55%.

What that means is that demand for physicians will only increase for the next decade, leaving a growing number of Mainers to navigate their health care without a PCP, potentially jeopardizing their health and incurring greater health care expenses.

Going back several years, area hospital officials say, it has been difficult for hospitals to staff PCP positions. But the problem grew when the pandemic struck.

In Maine, several factors are fueling the problem. First, not enough new physicians are going into primary care to replace retiring PCPs. At the same time, a growing local population and an aging Maine population are increasing demand.

Older patients tend to have more chronic conditions and need more services, said Rebekah Dube, Central Maine Medical Center vice president of Clinical Integration. That population is only growing and “certainly that puts more demand on an already taxed primary care system.”

Hospitals are faced with trying to meet the demand for new patients while also providing adequate service to patients already in its PCP system in the face of a PCP shortage, Dube added. One side effect: Many doctors are feeling pressure to take on more patients.

“It’s a tricky balance between wanting to take someone new on and knowing that you already have a lot of patients that you’re working to care for,” she said.

GIVING UP

Jacqueline Couillard says she found primary care services through Central Maine Healthcare’s residency program. The Lewiston resident moved back to Maine last fall after living in Virginia for almost 20 years and had been looking for a PCP but was not able to find one.

She had two separate medical events in November and December last year that landed her in the emergency room at Central Maine Medical Center, she said. She thinks she was connected to someone in the hospital’s residency program so quickly because her emergency room doctor helped make it happen.

Though it is not the same as having a PCP, and the residents only stay for a couple of years, Couillard’s needs have been met, she said. She was able to get referred to a cardiologist, which is a doctor most people can’t see unless they are first referred by a PCP or other primary care doctor.

Wait times for a new patient to be established with a Central Maine Healthcare PCP varies based on the person’s health needs or concerns, Dube said. CMMC has up to 70 PCPs among all of its offices and facilities.

Portland-based MaineHealth has close to 200 PCPs and close to 200 advanced practice professionals, such as physician assistants and nurse practitioners, providing care to patients, according to Rob Chamberlin, vice president of Population Health Management and Primary Care.

With nine local health systems spread across Maine, the MaineHealth system’s patient waitlists for a PCP vary from tens of patients to thousands — and those are the patients who have not given up on finding a PCP, Chamberlin said.

“There’s all those patients out there who have given up looking for primary care and that’s just awful,” he added.

One person who has given up primary care search efforts is Jay Reeves, who recently moved to Maine from Germany, he said. He never imagined that it would be so difficult to find a PCP, an important provider that he needs to help keep his diabetes under control.

He contacted both St. Mary’s Regional Medical Center and Central Maine Medical Center but, he said, providers at both hospital were not able to see him for several months. They offered to place him on a waitlist, but he felt it did not address the care he needed now so he declined.

“At the point where primary care groups are basically saying ‘We can’t see you,’ I didn’t think there was much of a reason to go on a waitlist for something that I needed right now,” he said.

Since moving to Maine last November, he has used urgent care clinics to refill his medications, which will last him another roughly eight months, he said. Urgent care and hospital emergency departments provide episodic care — care that does not include follow-up or help patients manage their health care after treatment. He said he has gone without blood work necessary to monitor his diabetes.

“So while I was able to get my medications, the true management of the situation, of my care, just doesn’t exist,” he said.

Should Reeve’s health decline and his diabetes get out of control, he will have to seek a specialist. Meanwhile, without a PCP there will be no one to help manage his overall care, he said.

PROVIDER PRESSURES

Deborah Mason just recently found a new PCP at Naples Family Practice after being diagnosed with cancer in late May, she said. Her longtime PCP left Central Maine Medical Center five years ago and no other providers at the hospital were accepting new patients at that time, so she went to St. Mary’s and started seeing a PCP there, which is where her neurologist was located.

Last spring she had surgery at CMMC, and while she was in recovery both her PCP and neurologist left St. Mary’s, she said. She was then assigned a physician’s assistant four months later through St. Mary’s.

When she tried to make an appointment with a St. Mary’s neurologist this year she says she was denied and told she was no longer a neurology patient because she had not been seen in over a year. She decided to seek providers from Central Maine, hoping to have more luck.

In an email statement to the Sun Journal, St. Mary’s spokesman Ben Sullivan said the hospital does not have a general policy in its neurology department removing a patient if they go more than a year without being seen. He could not speak about specific patients because of confidentiality. “At St. Mary’s, continuity of care for all patients is a top priority, especially when a provider retires or transitions out of market,” he stated. “Patients’ circumstances and needs can be very different, and we provide individualized guidance to ensure as seamless a transfer as possible.”

Mason said it was scary, stressful and frustrating after she got her cancer diagnosis and had no PCP.

The Albany Township resident lives more than an hour from Lewiston and 40 minutes from Central Maine Healthcare-owned Naples Family Practice, she said. Her new PCP, cancer specialist, urologist, endocrinologist and neurologist are spread across three CMHC-owned facilities in Naples, Bridgton and Lewiston, requiring her to travel to different areas for her care.

The MMA’s Jarvis concurred that PCPs are seeing an increase in the number of patients with complex health issues, such as diabetes, heart disease and obesity.

“When a patient is seen, they’re usually not just seen for one or two problems, they’re seen for five, six, seven, sometimes more than 10 problems at a time,” he said. “But the amount of time we spend with that patient has not increased over time.”

Each PCP tends to have a “panel” of patients, the number of patients per provider, said CMMC’s Dube. The demand on current PCP panels has increased and the need to take on more patients has increased. It is hard to quantify a good doctor-to-patient panel size, she noted, because certain considerations need to be factored in, such as provider experience and the level of patient care needed.

It also takes time for new PCPs to build a patient panel and get to know those patients, she said.

Trying to meet patient demand and dealing with more complex cases aren’t the only pressures PCPs face. One of the biggest, health care providers say, is additional, time-consuming administrative duties including prior authorization obligations by insurance companies.

One result of all the pressure is that many PCPs are getting burnt out by the situation, Jarvis said. It has caused some to go into specialty medical fields where they can make more money, while others are second guessing their decision to go into medicine altogether. Which makes the situation worse.

ANSWERS

Retired hospital nurse Pauline Castonguay decided to look for a new PCP this year before her PCP of over 20 years at St. Mary’s retired, she said.

After helping a family member search for a new PCP she knew she needed to look for a new one for herself sooner rather than later so she would not be in a situation where she had no provider, she said.

“Because of the experience I had looking for a PCP for this family member, I know what’s coming,” she said. “And so rather than wait and be in the middle of the scramble for a new one, I decided to jump ship. You know, I feel bad doing that but I’ve got to look forward.”

She was able to find a new PCP at MaineHealth’s Mid Coast Medical Group in Topsham, but she cannot be seen until early next year, she said.

Before she retired eight years ago, she says people were able to see a new PCP much sooner, but she acknowledged that things are much different in the medical field these days. “Times have changed.”

The MMA’s Jarvis says the PCP shortage, as difficult as it is at the moment, could be addressed if more changes were introduced to the system.

The administrative work required of doctors is one good place to start, he said. “We’re jumping through hoops that are unnecessary. And keeping us from spending the time with our patients because we’re doing that administrative burden.”

A 2023 American Medical Association survey of just over 1,000 physicians found that medical practices complete an average of 45 prior authorization requests per physician each week for insurance companies.

Physicians and staff spend almost two whole business days completing those requests each week, according to the survey. About 80% of those physicians have noticed the number of prior authorizations required for medications and services increase over the last five years.

The federal government can ease the burden on hospitals by initiating regulations around prior authorization requirements by insurance providers, Jarvis said.

Another insurance company-related target for change is how they reimburse for PCP visits. MaineHealth’s Chamberlin said commercial insurance companies usually only cover appointments in which a patient is seen by a physician, not appointments with nurse practitioners or physicians assistants. That needs to change, he said, to better fund primary care services, otherwise hospitals are stuck providing service in the most labor intensive and expensive way.

Jarvis agreed, saying he likes the idea of taking a team approach to PCP care, where nurse practitioners and physician assistants see patients with fewer medical needs and PCPs see patients with more complex cases, which is a system already being implemented in some hospitals, he said.

If private insurance companies established a base amount of funding for primary care services and allowed hospitals to be more flexible with what providers they use, it could result in giving care to more patients, he said.

Another suggestion is to attract more PCPs. On the state level, legislators and public officials should look at incentives to bring more physicians to the state, Jarvis said.

They should also look into the idea of creating a public medical school in Maine to make it more financially feasible for people locally to attend, he said, along with finding a way to subsidize the high cost of medical school.

And he said there should be more of a push to get providers training in the more rural parts of the state. There are some programs in hospitals now bringing medical students and residents into Maine’s rural hospitals in hopes that they might like it and stay. Hospitals also need to expand their recruiting efforts, reaching more providers.

And perhaps one of the broadest solutions calls for creating a single-payer system for primary care services. Jarvis said such a move would create a better system for physicians and patients, and has been endorsed by the Maine Medical Association.

A National Academies of Sciences, Engineering, and Medicine report about how to implement high-quality primary care services expressed the need to view primary care as a common good made available to everyone in the United States.

Jarvis only sees the PCP situation getting worse in the immediate future as more physicians retire, furthering that workforce gap between them and new physicians entering the field. However, making an effort now to get more medical students and residents into rural communities could pay off later, he said.

“I think we just need to get more students and residents into our rural communities and try to get them engaged in what it’s like to practice rural medicine,” he said. “I’ve been doing that for 20 years now and I absolutely love to take care of that particular population.”

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