Henry Tuttle has been trying for over a year to hire three doctors. The CEO and president of Outer Cape Health Services, a non-profit primary care clinic in Wellfleet has received 37 resumes and conducted 21 interviews over a one-year period.

So far, he's hired one physician's assistant. The problem? Many qualified candidates are leery about the high cost of housing, the lack of a major hospital and the region's general isolation.

"It's one of our key issues right now," Tuttle said of his doctor shortage. "We've got doctors pulling extra shifts. We are maximizing the capacity that we have."

Tuttle's dilemma is not unique.

A Massachusetts Medical Society study released in June showed that 54 percent of community hospitals around the state face a shortage of doctors specializing in internal medicine. The study also said 43 percent need more family medicine specialists. Dr. Bruce Auerbach of Sturdy Memorial Hospital in Attleboro, president-elect of the statewide medical society, referred to the lack of personal care physicians, general practitioners and internal medicine specialists as an "impending crisis" because the shortage is occurring just as an aging population is placing more demands on the health care system.

"If nothing is done to address the issues, it's hard to see any likelihood that the situation is going to get better," he said.

Auerbach traced the shortage to immense debt loads and other financial pressures on doctors leaving medical school and residency programs.

He also cited an insurance reimbursement system that is more lucrative for "procecure-oriented" specialists than generalists, who spend more time talking to their patients about stress, family histories and medicines.

According to the American Medical Association, in 2006, Massachusetts ranked 10th in the nation in total number of nonfederal physicians, with 32,785. But just 34 percent of those doctors practice primary care - the lowest rate among the 50 states.

The medical society report said shortages are more severe outside the state's major cities. The Springfield area, Berkshire County and the Cape and South Coast regions reported shortages at a higher rate than the Boston and Worcester metro areas.

An average of 71 percent of doctors around the state said there were not enough primary care physicians compared, with 87 percent of doctors surveyed in Berkshire County.

Those shortages appear to be having an affect on patient care.

The MMS study said that 53 percent of patients responding to a telephone survey in 2006 said they could get an appointment with their primary care physician within one week. By 2007, that had dropped to 42 percent.