NORTHAMPTON — When primary care physician Dr. Kate Atkinson goes to reunions, she’s usually met with this question from her peers: “Are you still practicing?”
And to their surprise, she still is, despite intense shortages within the field met with escalating rates of burnout. As these trends continue, her colleagues are leaving for direct primary care, aesthetics or functional medicine — areas where they can bypass insurance companies and pursue cash reimbursements directly from patients.
Atkinson, however, continues to see patients at Atkinson Family Practice, with offices in Northampton and Amherst. She continues to struggle with longtime problems primary care doctors face, including a lack of funding and mounting insurance paperwork, while many patients struggle to get an appointment at all.
“There are no primary care physicians accepting patients in our area,” she said in an interview Wednesday. Primary care is crucial, she added, since it offers preventative care rather than treatment after health problems have already set in — which also helps lower the overall cost of healthcare, she said.
After decades of advocacy, Atkinson sees a glimmer of hope after a sprawling bill passed the House last week to significantly boost investment in primary care. But it’s unclear if the funding will hold as the House and Senate now iron out details in conference.
In the meantime, she’s calling on residents to keep pushing for the legislation until it passes.
House Speaker Ron Mariano was lukewarm on the Senate’s primary care bill (S. 3141), saying senators passed their version last month “without any idea of how much it was going to cost.” But the bill (H. 5618), passed 158-0 on July 30, incorporates two hallmarks of the Senate approach: an aggregate primary care spending target and a new payment model moving away from a fee-for-service model.
“There are no primary care physicians accepting patients in our area.”
Dr. Kate Atkinson
The House envisions the state gradually spending 15% of all healthcare dollars on primary care by 2036; the Senate wants to hit that mark by 2030. Currently just 6.6% of commercial healthcare spending goes to primary care, according to the Center for Health Information and Analysis.
“The bill before us aims to address this problem. It does so incrementally, increasing the expenditures to 9% in 2030, 12% in 2033 and 15% ultimately in 2036,” said Rep. Greg Schwartz, a primary care physician, during his inaugural House floor speech Thursday. “It’s a significant increase in the primary care portion … done at a pace that gives our provider networks and insurance payers enough time to adjust their contracts to achieve these goals smoothly.”
Unlike the Senate version, the House bill sets only an aggregate spending goal rather than requiring individual healthcare entities to hit the target. Mariano said the longer timeline and allowances for safety-net versus teaching hospitals made the approach more workable.
“We make allowances for the different situations that different hospitals are in,” Mariano said, adding, “We put some options in there that we will count for participation … that aren’t financial, like hiring an extra nurse to keep your health center open another couple hours.”
The bill directs the Health Policy Commission to require primary care investment commitments from healthcare entities exceeding the state’s cost growth benchmark, exempting smaller physician groups — those with patient panels of 15,000 or fewer, or units earning less than $25 million in annual net patient revenue.
The legislation also requires commercial insurers to reimburse community health centers at MassHealth rates, mandates coverage of mobile integrated health services, and includes provisions on AI use in insurance reviews, pharmacy benefit manager oversight and drug rebates.
House and Senate negotiators now must reconcile the two chambers’ primary care packages.
Atkinson, a doctor in her 60s, said she likely won’t be practicing long enough to see the funding fully realized — but she still sees the fight as worth it. She said the bill would mean more staffing in primary care offices, as fewer physicians leave the field or retire early due to burnout. For patients, that means shorter wait times and increased availability.
“This bill would move us toward that 15% target gradually, over 10 years, while also cutting the prior authorization red tape that eats up hours of every PCP’s week, funding population and healthcare management work that currently goes unpaid, and putting real money into workforce recruitment,” she said.
