Why 45% of young adults don’t have a primary care physician — and what happens next

Nearly half of U.S. adults ages 18 to 29 don’t have a primary care physician — leaving millions disconnected from the health care system just as they begin managing their own care.

The gap, long overshadowed by discussions around access and insurance, is now drawing renewed attention from clinicians and health systems worried about the long-term effects of lost continuity.

One biopharmaceutical company, Ipsen, is hoping to help families address that gap with a new educational resource designed to prepare teens and parents for the transition to adult health care. But experts say the problem goes far deeper than awareness — it reflects a broader breakdown in how young adults enter the adult medical system.

The fragile handoff

The transition typically happens between ages 18 and 21, when patients legally become adults and must begin handling appointments, prescriptions and insurance on their own. But many young adults are unprepared, and pediatric systems often lack structured support for helping them make the shift.

“In the U.S., when a person turns 18, they’re considered a legal adult, and there are many changes that happen in the health care system related to that,” said Susan Shanske, clinical social worker and director of transitional care support at Boston Children’s Hospital. “The trouble is, we don’t prepare parents and kids for that transition in the way that we anticipate the shift from high school to college or work. That shift from pediatric to adult care can be just as disruptive and can result in young adults not getting the health care they need.”

According to a KFF analysis, 45% of adults ages 18 to 29 lack a primary care physician, compared with about 25% of adults overall. For those managing chronic conditions, the disruption can lead to missed medications, delayed diagnoses and otherwise unnecessary trips to the emergency department.

Early intervention and independence

Ipsen’s new website, Healthcare-Shift.com, offers tailored resources for children, teens and caregivers — including checklists, appointment guides and short videos intended to spark family conversations about medical independence. The company says its goal is to encourage parents to begin teaching these skills early, ideally before adolescence.

“Through our work in rare pediatric conditions, we’ve seen how critical it is for teens and young adults to feel supported in moving from pediatric to adult care,” said Keira Driansky, executive vice president and president of North America at Ipsen. “By offering families and providers tools to start these conversations earlier, kids develop the lifelong skills needed to manage their own health with confidence.”

The site breaks it down into three tracks:

• Big kids: Games and exercises for elementary-aged children to begin speaking up in medical settings.
• Teens and young adults: “Watch-together” videos, a health care checklist and appointment-planning templates to encourage self-management.
• Caregivers: Conversation guides and strategies for gradually transferring responsibility while maintaining oversight.

A wider systems challenge

Studies show the handoff between pediatric and adult systems is one of the most fragile points in a patient’s care journey. A 2020 review in the Journal of Pediatric Nursing found many young adults felt “lost” in the system after aging out of pediatric care, while a 2025 study in Health Care Transitions identified insurance complexity and cost as leading reasons for lapses in treatment.

For physicians, the fallout is increasingly visible — delayed preventive visits, unmanaged chronic conditions and lost opportunities for early intervention. Improving these transitions will require greater coordination among pediatricians, primary care physicians and families to ensure young adults don’t lose access to care at a critical time in their lives.