PITTSFIELD — Primary care is hard to come by in the Berkshires, and when it’s available, patients can face months or even years on waitlists.

When Meghan Crawford returned to the region last summer, she found herself stuck on a waitlist with no clear end.

“When we first started looking for primary care, just a few places were taking new patients, but everybody had a waitlist, and one place we connected with had a year-long wait,” Crawford said.

Crawford, a graduate of Mount Everett in Sheffield, moved from Colorado to Lee in August with her husband and two children. Before moving, Crawford’s mother warned her that finding a doctor could take time — something her mother experienced firsthand when it took six months to replace her own retired physician.

Senior Practice Manager Miriam Gluck gives a tour of the $1 million expansion of CHP Lee Family Practice in 2023. At the time, the expansion allowed the practice to add 1,500 more primary care patients over a span of years. Today, CHP is working on “waitlist management and improving access for the future.”

Crawford, an ADHD coach, was able to get her kids into a pediatrician fairly quickly, but finding a doctor for her and her husband has been “really hard.”

With so few primary care appointments available, patients often can’t choose a doctor who’s the right fit — they take whoever is available.

“You get what you get, and you don't complain,” Crawford said.

As a working mother, Crawford said finding a provider can fall down the priority list, especially when it takes multiple phone calls and there are few options.

“I believe in going to the doctor, getting preventative care, and when there are barriers in between getting that care and what we need, it's ultimately something that I'll put off,” Crawford said.

Crawford is one of many in Berkshire County — and across the country — caught in a shortage of primary care.

Of 21 primary care offices in the Berkshires contacted, only five said they are accepting new patients, while the rest reported waitlists ranging from three months to two years.

Physician assistant and Greylock Medical Clinic owner Jeff Kellogg said since opening his private practice in 2023, he has frequently heard from people who can’t find a doctor.

Physician assistant and Greylock Medical Clinic owner Jeff Kellogg opened his private practice in 2023. Despite the heavy workload and lower pay, Kellogg said primary care providers stay in the field because they love it.

“It's every day, people calling up saying, ‘I can't find anybody.’ ‘There's nobody even taking patients,’” Kellogg said. “It's a huge problem. There's just no access.”

Berkshire Health Systems, the county’s largest health care provider, plays an outsized role in determining access to primary care in the region. Spokesman Michael Leary said all primary care practices affiliated with BHS are technically accepting new patients, though wait times vary by office and patient need.

“But if you call up and say, 'I have diabetes' or 'I have high blood pressure,' all efforts are going to be made to get you in in a timely fashion,” Leary said.

BHS uses a team-based care model where providers share responsibility for patients, Leary said. It's a structure designed to expand access, but makes it difficult to determine how many of its 62 primary care providers — 35 physicians and 27 nurse practitioners and physician assistants — are actively taking new patients.

Community Health Programs — the county’s second largest health organization — has 31 primary care providers, and waitlists vary by site, ranging from six months to 1.5 years, spokesperson Amy Lisewski said. She added CHP is working on “waitlist management and improving access for the future.”

A patient visits with three members of Community Health Programs' medical team at the health center’s office in Great Barrington in 2022. CHP has 31 primary care providers, and waitlists vary by site, ranging from six months to 1.5 years.

As waitlists continue to grow across the county, Berkshire Health Systems CEO Darlene Rodowicz said it’s more important than ever for patients to rely on primary care — the most accessible and cost-effective form of care — even as workforce shortages and financial pressures strain the health system.

“It's really important that, as a community, we are continuing to access care in the lowest cost, most reliable relationship, which is at your primary care setting,” Rodowicz said. “I will say this is coming at one of the worst times it could come for health care, because we're not out of the woods with the workforce shortage.”

Regular primary care visits help catch health problems early and reduce unnecessary trips to urgent care or the emergency room, said Rebecca Caine, medical director of primary care at Berkshire Health Systems.

“Most health problems are managed in the primary care office,” Caine said.

Limited access to physicians isn’t exclusive to Berkshire County.

Primary care comes with a heavy administrative burden, including hours of charting, insurance paperwork and managing referrals. These physicians have to have a broad knowledge across many specialties rather than focusing on one area, and primary care roles are among the lowest-paid in medicine. Combined with soaring student debt, these factors make the field less appealing to new graduates.

“Every health system is trying to cope with it and deal with it, and I think we've made huge strides in trying to combat what is a very critical shortage,” Caine said.

Rebecca Caine, the medical director of primary care at Berkshire Health Systems, talks about the state of primary care at the hospital and its affiliated practices. "I think we've made huge strides in trying to combat what is a very critical shortage,” Caine said.

Some providers have turned to alternative models to manage the strain. Kellogg is the sole provider at his Lanesborough clinic, a membership-based concierge primary care practice. For about $350 a year, patients get direct access to care, including routine visits, faster scheduling and more time with their provider.

The model lets him keep a smaller patient panel, around 400, compared with the 1,500 to 2,000 patients typical in a traditional practice. He believes this allows him to provide the level of care patients deserve, something that can be harder in a corporate setting, he said.

But primary care isn’t highly profitable. Kellogg said the membership fee helps bridge the gap between the number of patients seen and what’s needed to keep the business alive.

The shortage is also driven by growing demand. Twenty to 25 years ago, patients seeing a specialist often had that doctor serve as their primary care provider, since all medical specialists complete internal medicine training, Caine said. But medical culture has shifted away from that model.

“So all of a sudden you have thousands of people who had one doctor who now needed more, so that increased the demand tremendously,” Caine said.

Despite the heavy workload and lower pay, Kellogg said primary care providers stay in the field because they love it. He said he practices primary care the way he believes it should be done, prioritizing patient care over corporate efficiency.

“This is truly a broken system,” he said.

Berkshire Health Systems has five new primary care providers coming on board by June and has offers to five others.

Nine primary care providers have come in over the last two years, but in general, six have left.

“Our goal is for someone to be able to call up and get an appointment in the office that is convenient to them when they need it,” Caine said.

The hospital system is planning to launch a centralized phone number that can help a new patient find a BHS provider without having to call each office individually.

“Those people in the community who currently don't have a primary care provider will have an easier avenue and not have to call six different offices or get on waiting lists or any of that,” Caine said.

BHS is launching a one‑year advanced practice providers' residency for new NPs and PAs in primary care to prevent burnout and prepare them to manage panels safely.

Berkshire Health Systems President and CEO Darlene Rodowicz speaks with U.S. Rep. Richard Neal at the Berkshire Innovation Center in Pittsfield about the state of health care in the Berkshires and nationally. “These are not quick fixes," she said of addressing the primary care physician shortage.

It also expanded its internal medicine residency by adding six positions specifically on a primary care track that are funded by Medicare/CMS GME slots. The first primary‑care‑track cohort matches this March and starts in July, but it’s a three-year lag before they become practicing PCPs.

“So this is a long investment we're making,” Rodowicz said. “These are not quick fixes.”

Certified Physician Assistant Jeff Kellogg has opened his own private practice at Greylock Medical Center in Lanesborough, offering membership-based concierge medical care to patients.

For new patients who are still waiting for an appointment and need to get in, Caine recommends calling again.

“I would call again because they may have been told that three months ago, and now things have changed,” Caine said. “We have new providers who have started in the last several months.”

There isn’t an easy way out for the health care industry, Kellogg said.

“I don't foresee an easy fix, certainly more doctors,” Kellogg said. “That's a seven-year process to get a new doc in primary care. PA is a little quicker in three years. NPs a little quicker yet, but they're going to need mentoring. So there's no easy fix. It's really hard.”

The lack of doctors is something that doctors themselves are worried about, with Kellogg and Rodowicz both saying they are worried about who will care for them.

“Hopefully, the U.S. can figure out something,” Kellogg said. “I'm not sure. I get a little worried, ‘Who's gonna care for me in 10 to 15 years, when I retire?’”

“I think about it like, someday I'll be one of those people in bed. Who's going to be caring for us?” Rodowicz said. “That's how we should all think about that. Is there an adequate workforce?”