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The latest report on primary care in the United States has unveiled a dire situation, indicating a deepening crisis fueled by a shortage of primary care physicians and inadequate funding. The report titled "The Health of U.S. Primary Care: 2024 Scorecard Report—No One Can See You Now," highlights how delayed and limited access to care has contributed to worsening health conditions and escalating costs. In fact, more than one-quarter of Americans have no usual source of health care, according to the report.
This urgent situation demands immediate action from federal and state governments, healthcare organizations, insurers, and stakeholders to bolster the primary care infrastructure. Yet how did we get here? And how do we move forward toward a better system, and thus, a healthier nation? Let’s dive into the valuable insights from this report.
1. Insufficient Primary Care Workforce Growth
Data from the report paints a concerning picture of the primary care workforce. Despite the nation's increasing healthcare needs, with more and more patients needing chronic care management, the number of primary care physicians per capita has experienced a steady decline. In 2012, there were 68.4 primary care physicians per 100,000 people, which has dwindled to 67.2 per 100,000 in 2021. In 2021, only 15.5% of newly minted physicians entered primary care.
Among new internal medicine doctors, the vast majority chose a subspecialty, such as cardiology or oncology, or became hospitalists, who are doctors solely focused on caring for patients when they are in the hospital. While 37% of all physicians in training were trained in primary care in 2021, just 15% were practicing primary care three to five years post-residency.
Primary care doctors work long hours, have higher stress levels, and are paid much less than doctors who specialize. And new doctors often graduate with a six-figure debt from their education, explains Dr. Barbara S. Spivak, a primary care doctor and is president of the Massachusetts Medical Society. “To choose a profession where you’re going to work harder and make less is not enticing,” Spivak said.
2. Underinvestment in Primary Care
Despite primary and community care's pivotal role in the healthcare system, funding allocated to this sector—both in provider salary and insurance support—continues to decline.
Since 2012, the investment in primary care as a share of total healthcare spending has dropped from 5.4% to 4.7% in 2021. This underinvestment is reflected in decreased Medicaid and commercial insurer funding for primary care since 2012, with Medicare investment remaining disproportionately low. The implications of this financial shortfall extend beyond recruitment and retention issues, impacting the quality and accessibility of care provided to patients.
Doctors say the system doesn’t support the core purpose of primary care, which involves preventing illness. Simply, insurance pays more for procedures.
“I could spend 20 to 30 minutes talking about really serious stuff—congestive heart failure, atrial fibrillation, diabetes… I might get $125,” Dr. Vicki Noble, a primary care physician, said. “If I brought someone in and burned off three warts with liquid nitrogen, which would take maybe 10 minutes, I would get paid $180.”
3. Challenges with Technological Integration
Primary care providers grapple with the burdens of electronic health record (EHR) systems, intended to streamline care delivery. However, more than 40% of family physicians report unfavorable EHR usability, with over 25% expressing overall dissatisfaction.
A study cited in the report reveals that 16% of family physicians spend four or more hours daily on EHR-related tasks, diverting valuable time away from patient care. The main culprit of the slowdowns? Insurance authorizations. One doctor described to The Boston Globe a situation in which she spent hours dealing with an insurer’s decision to stop covering a medication that was working well for a patient, and then getting authorization for an alternative. In that time she could have provided actual medical care to at least two other patients, she said.
This technological strain underscores the urgent need for solutions that enhance, rather than impede, primary care delivery.
4. Insufficient Research Funding
Research funding in primary care falls significantly short of meeting the sector's needs. Since 2017, only approximately 0.3% of federal research funding has been allocated to primary care research annually. This lack of investment stifles innovation in care delivery models, payment structures, and quality improvement initiatives within primary care. Furthermore, inadequate data about the primary care infrastructure hampers efforts to track progress and implement effective interventions outlined in previous reports.
Conclusion
The findings of the primary care report underscore the pressing need for immediate action to address the multifaceted challenges confronting the sector. There are some fixes in the works, though they will take years to bear fruit. State officials in Massachusetts, for example, are infusing an additional $115 million into primary care each year for MassHealth patients. Blue Cross says that it has increased its primary care network by 10 percent over the past five years and that 93% have openings within 45 days for routine or preventive care. The insurer is also trying to expand access with a new virtual primary care program. Some states are also working to bolster the primary care workforce with student loan repayment programs for providers.
By prioritizing investments in workforce development, infrastructure, and policy initiatives, stakeholders can mitigate the impact of the provider shortage and bolster access to high-quality primary care services. As the nation grapples with evolving healthcare needs, proactive measures are essential to ensure equitable access to primary care and improve health outcomes for all Americans.
Sources
Association of Health Journalists
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