U.S. primary care crisis worsens

A report from the Primary Care Collaborative and the Robert Graham Center reveals that the primary care crisis in the United States is deteriorating, driven by a clinician shortage and chronic underinvestment in the sector. As a result, an increasing number of Americans are finding it difficult to establish a regular primary care relationship. The report, "Health is Primary: Charting a Path to Equity and Sustainability," highlights the urgency of addressing this crisis by adopting a new payment approach and attracting a more diverse pool of health care professionals to the field.

According to the report, the United States has witnessed a consistent decline in the number of primary care clinicians since 2014, primarily due to fewer clinicians choosing primary care as a career path, burnout leading to retirements, and reduced direct patient care time. In 2019 alone, there was a net loss of 10 clinicians per 100,000 people across the country. Furthermore, spending on primary care has dwindled from an average of 6.2% in 2013 to a mere 4.6% in 2020.

Ann Greiner, president and CEO, PCC, emphasized the importance of high-touch, personalized primary care, supported by technology. She stated: “High-tech health care grabs the headlines, but high-touch, personalized primary care with tech support keeps people healthier at a lower cost. If we are serious about improving the health of everyone in every community, policymakers need to step up to strengthen primary care, making it attractive to clinicians and delivering what patients want – comprehensive team-based care.”

To address this crisis, experts recommend a multifaceted approach, calling upon policymakers, providers, and employers to take the following steps:

• Offering more primary care training opportunities and incentives to attract clinicians to select primary care as a specialty.
• Collecting accurate and transparent workforce and primary care financing data to inform decision-making.
• Establishing a hybrid primary care payment option as an alternative to fee-for-service, benefiting accountable care organizations (ACOs) within the Medicare Shared Savings Program (MSSP) and extending it across public and private programs.
• Creating solutions to mitigate barriers posed by high-deductible health plans, which often hinder primary care access.
• Supporting the primary care workforce by reducing administrative burdens and building diverse teams capable of addressing a wide range of patient primary care needs.

The report authors note the importance of establishing regular access to primary care. Such access is associated with fewer emergency department visits, reduced hospitalizations, lower premature mortality rates, and more affordable health care costs. Data from MSSP, Medicare’s largest ACO program serving 11 million beneficiaries, consistently indicates that primary care-focused ACOs, where over 75% of clinicians are in primary care, provide higher-value services on a population basis, resulting in over twice the savings compared to hospital-based ACOs. In 2022, MSSP saved Medicare $1.8 billion.

Currently, one in four U.S. residents lacks a relationship with a primary care clinician, and 40% of adults failed to have a primary care visit in 2019. These trends have been exacerbated by the COVID-19 pandemic, indicating that the situation may be even more dire than the report's data reflect.

Alison N. Huffstetler, MD, Medical Director at the AAFP Robert Graham Center, emphasized the critical need to strengthen primary care, stating: “The United States lacks the physicians and other clinicians needed to ensure that the front door of the nation’s health care system remains open. Recently, U.S. life expectancy declined by two years – worse for those without college degrees and from lower socioeconomic neighborhoods – and we will not reverse these declines unless we strengthen primary care.”

The report underscores the pressing need for immediate reforms and investment in the U.S. primary care system to ensure that all Americans have access to essential healthcare services and support population health and equity.