Finding a primary care doctor in western Massachusetts can be tough, especially if you’re new to the area. Patients often voice their struggles online, looking for recommendations. One name that keeps coming up is Valley Medical Group.
Founded in the 1990s, Valley Medical Group has become a staple in family medicine. With four locations along the Connecticut River and about 90 medical providers, they serve tens of thousands of patients, making them one of the largest independent practices in the region. Located in Northampton, their main office is conveniently next to a pizza restaurant and a Friendly’s diner.
However, the practice is facing significant challenges. In January, they laid off 40 employees, about 10% of their workforce. This is happening despite high demand for primary care services, with waiting lists to see doctors. Dr. Paul Carlan, the CEO of Valley Medical Group, explains that primary care providers often work harder but earn less than specialists. “Our insurance contracts don’t pay as much as they should,” Carlan said. “Costs are rising everywhere.”
This issue is widespread across the U.S. Many primary care practices are fighting to stay afloat. The American Association of Medical Colleges predicts a shortage of 86,000 primary care doctors by 2036. A recent study published in JAMA reported a 20% increase in individuals unable to find a primary care doctor over the last decade.
Financial strains worsened by the COVID-19 pandemic have contributed to many primary care practices closing. A report from the Massachusetts Health Policy Group in 2025 noted that low insurance reimbursement rates add to this crisis. The anticipated cuts to Medicaid could make the situation even more dire.
To combat these challenges, many practices are banding together in Independent Physician Associations (IPAs). These groups aim to boost their negotiating power with insurance companies while retaining control over patient care. Joining an IPA was a strategic move for Valley Medical Group, which allowed them to maintain their autonomy and avoid becoming part of a larger hospital system. Carlan emphasized that being part of a hospital can distract from patient-centered care.
Dr. Lisa Bielamowicz of TrustWorks Collective, a healthcare consultancy, shared that IPAs are becoming increasingly popular, especially as older doctors retire. Younger physicians are finding these models appealing. The American Association of Family Physicians has seen an uptick in practice owners looking to leave hospital systems to return to smaller, independent practices.
IPAs also help practices negotiate better terms with insurance companies. Some insurers prefer working with these associations, as they contribute to stabilizing primary care access. Direct primary care models, which sidestep insurance altogether, are also gaining traction as an alternative.
The payment landscape is changing, too. Blue Cross Blue Shield of Massachusetts is offering “value-based contracts,” where practices receive a budget for managing patient care rather than being paid per visit or procedure. While this method encourages preventive care, it requires a considerable patient pool to mitigate risks.
Chris Kryder, CEO of Arches Medical IPA, noted that if practices can keep patients out of emergency rooms and unnecessary hospitalizations, they not only save the healthcare system money, but also create more income for primary care providers, who desperately need it. These contracts offer flexibility in staffing, allowing other healthcare professionals to handle simpler tasks.
However, despite the potential benefits, IPAs are not a cure-all. Not all are structured to prioritize the needs and autonomy of doctors. For example, some IPAs are affiliated with larger hospital systems or private equity groups, which can shift the focus away from better patient outcomes.
As Valley Medical Group adjusts to its new association with Arches IPA, Carlan remains optimistic. Though they faced layoffs initially, he believes that financial stability will come, allowing them to offer better salaries and keep doctors in control.
This story is part of an NPR health reporting collaboration with New England Public Media and KFF Health News.
