Dr. Jean Antonucci has been a primary care physician in Maine for 35 years. She lives in New Portland.

It is widely reported that people cannot find a primary care physician. As a primary care physician in Maine for 35 years, I want the public to know what we do, and why access to us has become so difficult.

We can fix primary care to serve people again, to become the job many love, if society would find the will to address the kinds of issues I list here as examples:

• Insurers demand reports of quality measurements for payment. These reports are a huge source of time lost, with no improvement in national quality of care.
• HMOs (health maintenance organizations) require us to stop work to “refer” patients to ophthalmologists, radiation oncologists and others whose work primary care cannot do. If you need those specialists, you need them. No “gatekeeping” possible.
• Vaccine management requires recording fridge temps twice daily on paper — saved for three years — as well as logged in, while vaccines can only be accessed in boxes of 10 when one or three may be needed, and then require permission to return extra.

Running my own practice, I was proud of my systems and my service to people. Providing that service, however, became increasingly difficult. Instead of, say, calling the lab courier to pick up a specimen — a 15-second task — I had to log in and input the same name, address and door location, etc., every single day for five wasted minutes.

There are crazy issues in any job, of course. But this is not whining. Patients lose care as we are buried in worthless paperwork. In primary care, we come in early, find workarounds and pay someone to type what the patient said. Then spend computer time in the evenings.

So employment by hospital systems, by contrast, sounded great. Not so. Doctors, now employees, were asked to work ever faster, and computer systems that they did not choose were difficult to use.

Involved in internal matters now, they were blind as to what was happening to their profession. What was happening was undermining of their profession.

RVUs happened (relative value units). RVUs are a systematic valuation that underpays primary care, paying only for the time when patients are with us. The hours of required phone calls, referrals, checking labs, coordinating care are all without compensation. Hence, doctors spend less time with patients and do not follow up because they cannot afford to. We struggle to provide the care that people deserve.

Consolidation of hospitals happened. Prices went up. And facility fees happened, which raised prices even more.

And now there are effective gag orders. I have been told, and confirmed with others, that one hospital system here restricts its providers from talking about conditions at work.

I closed my office in 2020. I have been working one day a week caring for recovering addicts. It is fun to see people get well and get a place of their own, a job. But my position was cut because of system finances. I feel there is no money in the right places.

I write now because I cannot find work.

No one wants a part-timer. Can you imagine this, with Maine’s primary care shortages? Envision a doctor seeing complex patients and consulting with the mid-levels as needed, as a team. A great new model of care. Instead, the recruiters ask only: “How many patients can you see in a day?”

When I left my part-time job, people hugged me. One 41-year-old guy sobbed. But I cannot find a job.

Now you know why you cannot find a doctor. The job is unpleasant, though fixable. Many people find joy in it, but even those of us who would help out cannot.