CT’s primary care shortage is costing lives
Imagine a 58-year-old Hartford resident living with diabetes, high blood pressure, and depression. She has done everything right. She takes her medications, sees her primary care physician regularly, and is well enough to continue working and living independently.
Then her longtime primary care physician retires.
She begins calling practices throughout the region, only to discover that few are accepting new patients. Those that are have wait times of four to six months. As the weeks pass, her prescriptions run out. Her blood pressure climbs. Her diabetes becomes more difficult to control. She develops increasing shortness of breath but delays seeking care because she has no trusted clinician to call.
Six months later she arrives in the emergency department in heart failure. She spends several days in the hospital at a cost of tens of thousands of dollars.
The tragedy is that nothing about her illness was especially complicated. A handful of office visits, medication adjustments, and early intervention might have prevented the hospitalization. What failed was access to a continuous relationship with a primary care clinician.
This is what a primary care workforce shortage looks like. It is not simply an abstract staffing problem or longer appointment wait times. It is preventable suffering, avoidable health care spending, and, in some cases, preventable death.
This is not speculation. The Province of Ontario recently committed to ensuring that every resident has access to a primary care clinician by 2029 because its research shows that people without an ongoing primary care relationship experience significantly worse health outcomes, including a higher risk of death. Losing a primary care clinician has consequences that extend far beyond inconvenience.
Connecticut should take notice.
The state’s primary care workforce has been under increasing strain for years. Physicians are retiring faster than they can be replaced, many practices have closed their panels to new patients, and others have reduced the number of patients they see. Connecticut needs more primary care clinicians, but exactly how many remains uncertain.
Just looking at the numbers is not enough. Workforce needs estimates should account for communities requiring bilingual clinicians, physicians with expertise in caring for people with disabilities, behavioral health integration, rural communities, or other populations with specialized needs. And they must reflect the reality that physician panel sizes continue to shrink as practices attempt to reduce burnout and improve clinician retention.
More troubling, Connecticut does not even know precisely how many primary care physicians are currently practicing in the state. Because it lacks comprehensive, timely physician workforce data, it cannot accurately measure the size of its workforce gap. The federal Health Professional Shortage Area designations commonly used to estimate shortages were designed to determine eligibility for federal resources -—not to measure statewide workforce adequacy—- and they almost certainly underestimate the shortages patients experience.
Connecticut has many of the ingredients needed for success. The state is home to nationally respected medical schools and sponsors hundreds of graduate medical education residency positions each year. Yet too many physicians complete their residency training here only to establish practices elsewhere.
Research consistently shows that physicians are far more likely to practice in the state where they complete residency than where they attended medical school. Residency is where physicians establish careers, families, and professional networks. Every physician Connecticut fails to retain represents a missed opportunity to strengthen its primary care workforce.
Recognizing these challenges, Connecticut’s Physician Recruitment and Retention Working Group has submitted two reports to the General Assembly describing the state’s physician workforce challenges and recommending practical strategies to improve recruitment, retention, and the primary care practice environment.
Yet perhaps the most important recommendation has received relatively little public attention.
The Working Group recommended establishing a permanent Standing Committee on Physician Workforce.
That recommendation deserves immediate action.
A standing committee would provide sustained leadership to collect accurate workforce data, monitor trends, evaluate physician retention, and identify emerging shortages before they become crises. Instead of relying on intermittent reports, Connecticut would have an ongoing mechanism to guide workforce planning using current evidence.
The committee should also be adequately funded and empowered to answer questions Connecticut currently cannot. How many primary care physicians are actively practicing? Where are shortages greatest? How many residency graduates remain in Connecticut? How many residents have access to continuous, relationship-based primary care?
These are not academic questions. They are essential measures of whether Connecticut residents have access to the care that keeps people healthy and prevents unnecessary hospitalizations.
Which brings us back to our Hartford resident.
Her story illustrates more than a shortage of physicians. It illustrates the value of continuity. Primary care is not simply about obtaining an appointment when you are sick. It is about having a clinician who knows your medical history, helps manage chronic illness, recognizes subtle changes in your health, and intervenes before small problems become medical emergencies.
Continuity of care saves lives. It reduces hospitalizations, lowers health care costs, improves patient satisfaction, and increases life expectancy. Yet Connecticut currently has no reliable statewide measure of how many residents enjoy that continuity—or how many have lost it.
We cannot improve what we do not measure.
The first step toward solving Connecticut’s primary care shortage is understanding its true scope. The General Assembly already has a thoughtful roadmap from the Physician Recruitment and Retention Working Group. It should now act on its central recommendation by creating and funding a Standing Committee on Physician Workforce charged with collecting the data, monitoring the workforce, and guiding long-term policy.
Connecticut has the expertise, the institutions, and the recommendations. What it needs now is a commitment to act.
For thousands of residents searching for a primary care clinician, the cost of waiting is measured not simply in dollars, but in lost health, lost opportunities, and, for some, lost lives.
Howard Selinger M.D., Margaret Gradie, George Reigeluth, Vida Javidi and Wendy Barr M.D. write for Primary Care For All Americans.
