PROVINCETOWN — Nick Jefferson lives to rock climb. “I work so I can go climbing,” he told the Independent. So, when Jefferson, who moved to Provincetown in 2013, cut a climbing trip in Red River Gorge, Kentucky short because of health concerns, he wanted to see his doctor at Outer Cape Health Services (OCHS) immediately.

That didn’t happen.

OCHS has been struggling to recruit and retain staff in the face of a nationwide primary care physician shortage.

In November of last year, the U.S. Health and Human Services Administration estimated that the country will face a shortage of over 68,000 primary care physicians by 2036. That shortage is already acute in rural areas and is expected to worsen.

In response to questions from the Independent, OCHS CEO Dr. Damian Archer, who took over the organization last December, wrote: “The extended wait period for new patients to establish care with primary care physicians is a well-documented nationwide issue, and not unique to Outer Cape Health Services.”

Even before flying back from Kentucky, Jefferson scheduled an appointment with his physician, Dr. Cody Nolan, for April 30. But on the morning of the appointment, he got a call saying his appointment was canceled. In a make-up appointment later that week, Jefferson said he saw a nurse practitioner who showed up one hour late and told him he was likely experiencing bad allergies.

Jefferson said he was sure it was not just allergies but figured he could wait until a physical with Dr. Nolan scheduled for June 4, which would include blood work. About a week later, on May 8, he received a letter from OCHS informing him that Nolan would be leaving the organization in July, but OCHS would “do everything possible to provide you with continued support through the transition.”

On the morning of his June 4 physical, Jefferson’s appointment was canceled again. He told the Independent that an OCHS representative told him the next available appointment would be in July.

“I was super distraught,” said Jefferson. Instead of waiting, he took an available appointment with Dr. James Dwyer in Wellfleet on June 7, nearly six weeks after he cut his trip short and months after his symptoms began.

Interviews with Jefferson and five other patients at OCHS revealed a few common themes: appointments that are canceled at the last minute, referrals to specialists that languish, and extreme difficulty getting answers over the phone.

Several patients reported being left in limbo for months, waiting for a doctor, a referral, or someone just to call them back.

Archer did not respond to the Independent’s request for information about how many open physician jobs his organization is currently trying to fill or the organization’s plans to address other concerns relayed by patients to the Independent.

Archer wrote that since the start of the year, however, OCHS has reached out to every patient on its waiting list and has already scheduled more than 750 patients to establish care. In Provincetown, over 120 patients are scheduled to establish care by the end of the summer.

Based on multiple phone calls with OCHS operators in June, there are currently no male doctors in Provincetown accepting new patients.

Phones and Referrals

When Cass Johnson moved to Truro in 2021, he said, it took him nine months to be assigned a primary care physician. Once he got a doctor, he ran into a new problem: OCHS’s referral system.

Johnson told the Independent that it took six months for OCHS’s referral desk to send a referral for a colonoscopy to a doctor in Hyannis in 2022. In those six months, Johnson said he followed up with OCHS on four separate occasions. It was only after he threatened to file a complaint that they sent the referral, according to Johnson.

Last year, Johnson said, he went through a similar ordeal. His doctor, Paul Fader, identified a lump under his jaw and ordered a biopsy. After waiting three months, Johnson realized that OCHS had once again failed to send out the necessary paperwork. Once the referral finally got to the specialist, Johnson said he had to wait three more months for an appointment.

According to Johnson, the problem is that patients have no way of knowing whether OCHS actually sends out a referral. He received multiple notifications in his “patient portal” that a referral had been requested, but he received no confirmation that one had been sent and no information about who should be receiving it.

“It’s such a messy system,” said Johnson, who is considering abandoning OCHS.

Scot Rabosky, a resident of Yarmouth Port who goes to the OCHS clinic in Harwich, told the Independent that it took him over two years to establish care. He has been trying to get a colonoscopy referral for over a year and a half.

“It’s been a humongous hassle,” said Rabosky. “Every time I call it’s an answering machine.”

Even those intimately familiar with the organization can struggle to get through by phone.

Janet Whelan, who worked as a doctor at OCHS from 1999 to 2012, told the Independent that she always goes in person rather than trying to call.

“The phone business is terrible,” said Whelan. Nonetheless, when she goes to the clinic in person she always receives high-quality care, she said.

“This town is dependent on Outer Cape Health because it’s here,” said Whelan, who also said that OCHS was on the forefront during the AIDS crisis. Whelan, like almost every person interviewed for this story, said that despite its faults, she believes in the organization.

Keeping Faith

The contrast between the challenges many patients face accessing care and their commitment to the organization as a whole underlines the central role OCHS plays in the region’s health care.

“It’s not like I’ve lost faith in Outer Cape,” said Provincetown patient Cary Bryant — even though he, like many other patients, has been in the dark the past few months.

Bryant has been suffering from Long Covid since July 2021, but after a steady decline, he started seeing Dr. Nolan at the Provincetown clinic. Nolan and Bryant developed a care plan Bryant felt confident in, including care from a clinic in Boston that specializes in Long Covid treatment.

After Bryant received a letter announcing Nolan’s departure from OCHS, he wondered what that would mean for his care. Like Jefferson, Bryant also had a June 4 appointment with Nolan that was canceled.

Despite concerns for his own health, Bryant said he sympathizes with the difficulties OCHS faces.

“I’m not mad or frustrated with Dr. Nolan,” he said. “I am frustrated with not knowing what is going to be happening. It would be nice to understand why Outer Cape has such a hard time recruiting doctors.”

On June 25, as this edition of the newspaper was going to press, Bryant told the Independent that he had received a letter from OCHS telling him he had been assigned a new doctor in Provincetown.