First, her favorite doctor in Providence, R.I. retired. Then her other doctor, at a health center a few miles away, left the practice. Now, Piedad Fred has developed a new chronic condition: distrust in the American medical system.

"I don’t know,‘’ she said, eyes filling up. "To go to a doctor that doesn’t know who you are? That doesn’t know what allergies you have, the medicines that make you feel bad? It’s difficult…I know that I feel cheated, sad, and like I have my hands tied.‘’

At 71, she has never been vaccinated against COVID-19. She no longer gets an annual flu shot. And she hasn’t even considered whether to be vaccinated against the respiratory syncytial virus, or RSV, even though her age and asthma put her at higher risk of severe infection.

"It’s not that I don’t believe in vaccines,‘’ Fred, a Colombian immigrant, said in Spanish, at her home one morning last fall. "It’s just that I don’t have faith in doctors.‘’

The loss of a trusted doctor is never easy. But it’s an experience that is increasingly common.

The stress of the pandemic drove a lot of health care workers to retire or quit. Now, a nationwide shortage of doctors and other professionals who provide primary care is making it hard to find replacements. And as patients are shuffled from one provider to the next, it’s eroding their trust in the health system.