The Bay State is already struggling with a primary care provider crisis, and the head of the largest not-for-profit health care system in Central Massachusetts sees an increasingly grim road ahead if current trends persist. 

This week on the monthly Health or Consequences episode of The Codcast, John McDonough of the Harvard TH Chan School of Public Health and Paul Hattis of the Lown Institute speak with Eric Dickson, president and CEO of UMass Memorial Health. 

“It pains me, especially as an emergency physician, to look at the trajectory of some of the key metrics and health care in this state,” Dickson said.  

Massachusetts now has the third longest ER wait times in country, which Dickson said is a reflection of a decline in primary care access.  

“Primary care is the foundation of any good health care system, on a national or state level or regional basis,” he said. “So you don’t have primary care. Patients can’t get seen early. They end up in the emergency department later, in the course of their disease, which explains a lot about why healthcare costs so much in the state of Massachusetts.” 

Medical universities are struggling to produce enough physicians to keep up with the need, he said.  

UMass Chan is one of only two New England medical schools to rank in the top 10 percentile for primary care education, he noted. But students attending the school – where Dickson himself studied medicine – are now paying far more than he did or are doing the math and concluding that working in primary care and paying back loans to cover $70,000 a year in out-of-state tuition is unmanageable. 

And federal headwinds are not helping the broader health landscape, he said. For hospitals that have a large number of patients on Medicaid, like UMass Memorial, they will be greatly impacted by the coming cuts to Medicaid signed into law on July 4 by President Trump in his sweeping tax and spend bill. 

But the scale of damage is still hard to pin down, Dickson said, because new work requirements for Medicaid recipients will go into effect in October 2026 and take some unknown number of people off of their coverage. Plus, the new federal posture on vaccinations from Health and Human Services Secretary Robert F. Kennedy Jr., who has a long history of vaccine skepticism and is rolling back recommendations and research into vaccinations, will likely lead to resurgences in long-forgotten diseases, Dickson said. 

“This will become a nation of people with chronic disease,” he said. “And as the population, ages and medications get better to keep people alive longer, it’s a little bit scary to think about the shortage of primary care that exists today, and how bad that will be 10 years from now, if something doesn’t change.”