Two weeks ago, Dr. Marlene Shute began seeing patients out of the newly renovated Lawrence + Memorial Medical Group offices on Howard Street in New London, from a middle-aged woman who hadn't been to a doctor in 20 years to several who sought her out because she speaks Spanish.

"They were tired of not getting their message across," said Shute, recalling her own experience as a child translating for her Spanish-speaking grandmother.

One of the most common problems she's been dealing with, she said, is patients who've stopped taking medications for chronic conditions such as diabetes, because no one ever explained why they needed it.

"Noncompliance is a very big issue in underserved populations," Shute said. "I never offer a prescription for anything unless I explain to them why they should take it. I'm very big on counseling. It helps with compliance."

Shute, 34, moved with her husband, Michael, and infant daughter, Sarah, from the Bronx, where she grew up and had worked in private practice since completing medical school residency in 2012, to become one of the eight new primary care providers joining the L+M network over a yearlong period that began last fall. Elsewhere in the region, Hartford HealthCare, parent of The William W. Backus Hospital in Norwich, has hired eight primary care providers over the last year, and the region's largest primary care clinics - United Community & Family Services in Norwich and the Community Health Center in New London and Groton - are also aggressively seeking to expand the ranks of their family doctors, advanced practice registered nurses and physician assistants.

"Nationally, there is renewed interest in primary care," said Kent Stahl, vice president for physician network development for Hartford HealthCare. "We want to build a system that supports primary care, because that's the key to value in health care."

Throughout the region, primary care providers say demand for their services has increased as a result of the Affordable Care Act, as previously uninsured patients are now putting their coverage to use. One local physician assistant said about 50 newly insured patients have come for appointments over the last year. Megan Stone, advanced practice registered nurse at UCFS, said helping the new patients with longstanding problems has been especially gratifying.

"One of the new people was a woman with untreated hypertension who's had terrible headaches for years, but she had no insurance so she didn't go to the doctor," said Stone, who has been caring for patients at the Norwich clinic since 2012. Now that the woman's hypertension is under control with medications, Stone said, the headaches have stopped.

"I wanted to get into primary care because that's where I thought I could do the most good," she said.

Sue Barrett, regional director of physician practice operations for the Backus region, said she is now waiting to hear back from two more primary care doctors who have been offered positions in the Backus network. They would become the newest additions after Dr. John Greeley and physician assistants Jennifer Felicelli and Gabrielle Pierce began seeing patients last summer at the hospital's new Waterford facility.

"I wanted to move to this area, and I was looking for a good culture to work in, where you're treated like a health care provider rather than a revenue provider," said Greeley, who had been in private practice in Fairfield County for 30 years. "Now I'm able to spend quite a bit of time getting to know my patients, their medical needs and talking about making lifestyle improvements."

Remo Laureti of Stonington has been a patient of Felicelli for about 15 years, following her to the new Backus facility in Waterford after the physician she had been working with in Mystic closed his office. Getting his primary care from a physician assistant, he said, suits him well because of the good relationship they've built up over the years.

"I like Jennifer because she's very, very easy to talk to, and she listens to your questions," said Laureti, 57, who saw Felicelli last week for the annual physical required for his job as a crane operator at Electric Boat. "She spends a lot of time with you. She's not pushing patients out the door."

With increasing demand for primary care doctors and supply not expanding to match, more health care providers are looking to "physician extenders" - physician assistants and advanced practice nurse practitioners who work under a doctor's supervision - to fill the gap. Gene Gagnon of Norwich, a patient of APRN Stone for the past two years, said that makes sense to him, based on his experience with the care he's received for his migraine headaches and other illnesses.

"They're that close to being a doctor," he said, scissoring his thumb and index finger close to each other. "Megan is very caring and down to earth."

But even with the addition of physician assistants and APRNs, there is still a need for primary care physicians, including family doctors, internal medicine doctors, pediatricians and geriatricians. Christopher Lehrach, president of the L+M Medical Group, notes that nationally, there are an estimated 49,000 openings for primary care physicians, making the recruitment process very challenging. Nevertheless, that's where all the medical group's recruiting efforts are currently focused.

"We've put all other hiring on hold except for internal medicine, family practice, OB-GYN and pediatrics," he said. "You have to have primary care as the foundation of a healthy health care system."

To attract new physicians, recruiters at the two hospitals and the two clinics promote the region's shoreline, good schools for their children and proximity to New York and Boston. They are also offering newly renovated, modern offices and incentives such as guaranteed salaries for the first one to two years while they build up their patient rosters. Lehrach said LMMG makes about two offers for every one that's accepted, but remains choosy even in this competitive field to find doctors who would be a good match. That includes seeking out doctors willing to "meet the patients where they are" with extended hours and language skills, and who accept the realities of the current health care landscape, in which Walmart and CVS are opening primary care clinics.

"One of our new hires speaks Cantonese," he said. "Convenience is also very important to patients, so we're adding Saturday hours. Access and convenience are what patients care about."

Tim Spagnola, clinical recruiting manager for the Community Health Center, said that in addition to trying to hire eight new primary care providers for the center's 13 offices statewide, he's also focusing on retention of existing staff by "doing our best to assist them in achieving work-life balance."

"There is too much competition, and there are many options available to today's primary care providers," he said.

Dr. Jennifer Pothen, who joined UCFS in 2013, said she still gets pitches from recruiters, even though she's happy to stay where she is.

"I'm getting two recruitment emails every day," she said. "But I believe in what UCFS is doing, and in what they're doing in the community."

While most of the region's primary care providers today work for one of the hospital networks or the clinics - a transition over the last two decades from the independent private practice model - there are still primary care doctors who maintain their own offices. One is Dr. Steven Johnson, who has cared for patients with three other doctors at New London Family Practice for the past 29 years. The recruiting successes the hospitals and clinics have had thus far, he said, don't seem to be enough.

"We've been closed to new patients for a couple of years now, and we still get 20 to 30 calls a day from people looking for a primary care doctor who can't find one, so I guess there is a shortage," he said.

He enjoys the variety of patients, from infants to his oldest, a 102-year-old, and the variety of health needs they bring.

"I thought it would be awfully boring to do the same thing all day long," he said.

Mystic physician Thomas Blum and his partner, Dr. Rosemary Bontempi, have also avoided signing onto one of the hospital networks, but joined MDVIP, a company that turns private practices into what are commonly called "concierge" practices. They made the conversion last year, limiting their practices to 300 patients each who pay an annual retainer. Dr. Blum, who had about 1,500 patients on his roster for most of the 27 years he's been a doctor, said he believes he is providing better care to fewer patients, enabling him to keep practicing medicine instead of getting burned out and retiring.

"From the numbers point of view, this (concierge practice) is not a solution," he said. "But this type of doctor-patient ratio will show benefits, and if it's a better situation for doctors, more might want to go into primary care."

Salaries of primary care doctors, which are one-half to one-third that of their counterparts in specialties, are just one of the obstacles to attracting medical school students into primary care, said Dr. Rebecca Andrews, assistant professor of medicine at the University of Connecticut medical school. Andrews is also associate program director of the Internal Medicine Residence Program at UConn, a new program working to address primary care shortages in the state. She quoted research that estimates there is a deficit of 90,000 primary care providers nationally.

Part of the problem, she said, is that medical school students have had few opportunities to spend all or part of their residency time in primary care offices. Instead, most residency time is spent in hospitals, which has led many students interested in general medicine to become hospital-based doctors called hospitalists, rather than general practitioners.

"Four years ago we started a track called office-based medicine, to expose students to urban- and suburban-based office rotations," she said. "They learn about primary care diseases, the physical skills and the patient skills."

Of the 15 students who have graduated the program thus far, 12 have gone into primary care, she said.

This region's new primary care providers hail from a variety of backgrounds, but when asked why they chose a field too few others are entering, they express a common sentiment. Being a primary care provider, they said, fulfills an altruistic motivation, as well as a love for variety and providing personal care.

"The whole reason I went into primary care was to serve underserved populations, and to get to see the patient as a whole, rather than focusing on one process," said Shute.

j.benson@theday.com

Twitter: @BensonJudy