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A CARDIOLOGIST, A GASTROENTEROLOGIST, an ear/nose/throat surgeon, and a family physician walk into a bar. That sounds like the beginning of a joke, but it’s actually the make-up of an unusual coalition.

As doctors who practice specialty care and primary care medicine, we are following the debate on Beacon Hill over how to address the state’s growing primary care shortage. “Senate ready to force more money toward primary care — and away from specialists” was the headline of a recent CommonWealth Beacon article. We don’t think this is about choosing between primary care and specialty care. It’s about creating a health care system that depends on both in a way that works best for patients.

The legislation passed by the state Senate would require a ratcheting up of the share of health spending devoted to primary care from its current level of less than 7 percent to at least 15 percent of the overall health care spend in Massachusetts. The legislation also calls for the change to have no net impact on overall health care spending, insurance premiums, or cost sharing (copays and deductibles).

We see, every day, how the erosion of primary care undermines our ability to care for patients. We support the greater investment in primary care called for in the bill passed by the Senate.

Primary care clinicians are overwhelmed by a payment system that asks them to address acute concerns, coordinate complex care, manage multiple chronic conditions, provide preventive services, and navigate countless administrative demands, while failing to adequately pay for the time, expertise, and long-term relationships that make high-quality primary care possible.

The result is predictable. Fewer medical students choose careers in primary care. More physicians leave independent practice or reduce their clinical hours. Patients wait months for appointments, if they can even find a primary care clinician at all.

We understand why some specialists worry that strengthening primary care will come at their expense.

We see it differently.

A healthy primary care system ensures that specialists spend their time on the patients who truly need their expertise instead of managing uncontrolled hypertension because a patient couldn’t get a primary care appointment, renewing routine medications, or coordinating care that should already have been coordinated if primary care had the bandwidth and resources that it needed.

When specialists spend more time seeing clinically appropriate referrals and more time focusing on what they were trained to do, their work becomes more impactful and more satisfying. When primary care collapses, referrals become less organized, follow-up deteriorates, and specialists become de facto primary care physicians due to limited access to primary care.

This also has a profoundly negative effect on access to specialty care. It pains specialists not to be able to offer timely access to our patients. We understand that when a primary care clinician cannot access a specialist for their patient, they often need to do our work.

Ironically, chronic underinvestment in primary care has created a reality in which specialists increasingly provide primary care, while primary care clinicians increasingly provide specialty care. Neither group was trained for this, neither group wants it, and, sadly, it is patients who suffer the most because of this.

The three of us who practice in specialty areas are delighted to co-manage and collaborate on patient care with our primary care colleagues. We also enjoy making a decent living, but money is not why we do the work we do. Like our primary care colleagues, we are devoted to our patients and their well-being.

Some fear that investing in primary care will reduce referrals to specialists. The opposite is more likely.

In a 2023 survey by the state Center for Health Information Analysis, 41 percent of Massachusetts residents reported difficulty accessing health care, most commonly because they could not obtain a primary care appointment when they needed one. These patients are not receiving specialty care instead of primary care; they are receiving neither. Expanding access to primary care generates thousands of additional patients under the health care tent who will need specialty care.

For all these reasons, specialists cannot afford a continued erosion of primary care.

Every specialist depends on a healthy primary care system. It is the front door to health care and the foundation upon which the rest of medicine is built. Supporting primary care is not an act of charity toward one specialty. It is an investment in a health care system that works better for everyone, including specialists.

There is broad consensus that increased investment in primary care should not increase overall health care costs or insurance premiums. This principle is embedded in the Senate bill. The obvious question is where the money comes from. Fortunately, we don’t have to guess.

The Massachusetts Health Policy Commission recently reported that approximately 40 percent of emergency department visits involve conditions that could have been treated or prevented altogether in primary care. Primary care is one of the most effective tools we have to reduce waste throughout the health care system. Those savings could effectively fund the proposed doubling of primary care investment in Massachusetts.

This debate has never been about specialists versus primary care. In our daily practice, we rely on each other. We care for the same patients, celebrate the same successes, and share the same frustrations when the system fails them.

If policymakers are looking to control health care costs, physician salaries are not where meaningful savings will be found. The far greater opportunity lies in reducing preventable ER visits, avoidable hospitalizations, duplicative testing, and fragmented care, all of which become less common when patients have timely access to strong primary care.

The evidence has been remarkably consistent around the world. Health systems with robust primary care produce better outcomes, lower costs, fewer avoidable hospitalizations, and greater equity. Patients don’t simply live longer; they experience more coordinated, more humane care, which generates a higher quality of life.

Massachusetts is home to some of the finest hospitals in the world. But world-class specialty care cannot compensate for a collapsing primary care infrastructure. If patients cannot find a primary care clinician, everyone downstream pays the price, including specialists.

The strength of our health care system will ultimately be determined not at its peaks, but at its foundation.

Mario Motta is a cardiologist and former president of the Massachusetts Medical Society. David Fefferman is a gastroenterologist in Stoneham. Andrew Scott is a pediatric otolaryngologist in Boston. Wayne Altman is a family physician in Arlington.