Why physicians face growing demand but shrinking investment in 2026

The American health care landscape is currently defined by a stark paradox. While health systems are doubling down on primary care as a strategic cornerstone for value-based care and cost management, the actual investment in the field is shrinking, and the physicians required to lead this charge are becoming increasingly scarce. According to data from the Health Care Cost Institute (HCCI), primary care spending in the U.S. represents a mere 4.39% of total health spending—a figure that is actively declining from previous years. At the same time, the industry faces a looming physician shortage projected to reach between 86,000 and 124,000 within the next decade.

For physicians navigating this environment, the challenge is no longer just clinical; it is a matter of business sustainability and professional evolution. Michael Suk, MD, MBA, an internationally recognized orthopaedic surgeon and health care policy leader, says that the path forward requires a fundamental shift in how practices are designed and how physicians engage with the broader healthcare ecosystem.

The hub of the system: Redefining access and alignment

The systemic reliance on emergency departments (ED) for routine care is perhaps the most visible symptom of a fragmented primary care infrastructure. Suk says that approximately 60% of ED visits stem from preventable conditions. This costly trend exists because patients naturally seek care where it is most quick and reliable. When primary care access is delayed or fragmented, the ED becomes the default entry point.

Suk says the solution lies in addressing these fundamental access gaps. "Patients generally seek care where they know they will be seen quickly and reliably," Suk says. He notes that moving the needle on these statistics requires more than just adding appointments. "Strengthening primary care therefore requires both operational and financial alignment around prevention and continuity," he says. "When primary care practices are supported as the central hub of patient care—with appropriate staffing, infrastructure, and reimbursement—many of the conditions that currently drive emergency department utilization can be addressed earlier and more effectively.”

This vision of the central hub aligns with current corporate trends. Bain & Co.’s 2025 Primary Care at Health Systems Survey found that 77% of health executives plan to expand their primary care footprint over the next five to seven years. These organizations are betting on primary care to improve clinical outcomes and manage medical costs—ranking these goals far above traditional metrics like driving referrals. The shift from fee-for-service to population-based models is accelerating, with systems building population-focused primary care centers that emphasize chronic condition management and patient engagement.

The workforce crisis: Team-based solutions

The most significant threat to this strategic expansion is the labor shortage. Health executives now rank physician recruitment and retention as their top priority, surpassing even financial performance. With one-third of currently active physicians expected to retire within the next decade, the pressure on the remaining workforce will be immense.

Institutions are already responding to these projections. The University of Maryland School of Medicine, for instance, has received approval to expand its class size to 200 students by 2031 to bolster the physician pipeline. This expansion is part of a broader effort to address the national shortage, which includes rural health initiatives and technology-driven programs designed to attract a new generation of medical professionals.

Suk says that primary care physicians should prepare for increased patient loads by embracing physician-led, team-based care models where the physician sits at the apex of a diverse clinical team. "Preparing for increased demand begins with thoughtful practice design," Suk says. "Primary care functions best in physician-led team-based care models where nurses, advanced practitioners, pharmacists, care coordinators, and other professionals contribute fully to patient management.”

By allowing these professionals to contribute to their full scope of practice, the physician can focus on high-level diagnosis and the longitudinal relationships that are the bedrock of effective primary care. Suk adds that, "practices that intentionally build these teams and systems tend to be more resilient, allowing physicians to care for larger populations while maintaining sustainability in their work.”

The financial reality: Reclaiming the value of cognitive care

Despite the strategic importance placed on primary care, the financial data reveals a different story. The 4% the U.S. spends on primary care is significantly lower than that of other developed nations. Furthermore, nearly every state saw a decline in the share of employer-sponsored insurance spending dedicated to primary care between 2018 and 2022.

This marginalization of primary care creates a precarious environment for independent practices. The American Medical Association points out that the Medicare payment system is antiquated, with physician reimbursement dropping by more than 33% since 2001 when adjusted for inflation. Suk says that meaningful reform must include payment models that better recognize the complexity of non-procedural care.

"Young physicians increasingly evaluate whether a career in medicine is sustainable over the long term. Educational debt, compensation disparities among specialties, and the intensity of clinical practice all influence those decisions," Suk says. He advocates for specific reforms to shift this trajectory, noting that "loan relief tied to primary care service, expanded support for community-based residency programs, and payment models that better recognize cognitive care would help address some of those pressures.”

For the next generation of physicians, financial sustainability and career breadth are primary concerns. Suk says that "sustainable careers increasingly include opportunities beyond the exam room—leadership, innovation, education, research, and policy engagement. When physicians can apply their expertise across a broader professional landscape while maintaining meaningful clinical practice, the profession becomes more attractive to the next generation.”

Navigating large organizations and career strategy

As health care organizations grow and become more complex, physicians are increasingly finding themselves in employment models that require sophisticated negotiation and strategic planning. Suk says that navigating these large systems can be a daunting task for individual clinicians.

"As health care organizations grow larger and more complex, physicians often benefit from structured guidance when making important career decisions. Increasingly, physicians are seeking access to trusted advisors who can help them evaluate opportunities, interpret contracts, and think strategically about the arc of their careers," Suk says.

This need for mentorship and strategic career support is giving rise to new professional models. Platforms like MDEnvoy are emerging to provide physicians with coordinated support around their broader professional success, including mentorship and leadership development. This support often extends beyond employment negotiations to help physicians find pathways outside direct clinical practice that complement their medical careers.

Retention and the efficiency of care

Retention is just as critical as recruitment. To keep experienced physicians from leaving clinical practice, Suk says that health care systems should take action.

"Retention begins with creating environments where physicians can focus on patient care rather than administrative complexity. Health systems that support physician-led teams, efficient clinical workflows, and reduced documentation burden create conditions where physicians can practice effectively and sustainably," Suk says.

Furthermore, organizations benefit when they recognize the invaluable clinical judgment of veteran doctors. “Experienced physicians bring invaluable clinical judgment and institutional knowledge, and organizations benefit when they create opportunities for those physicians to contribute through teaching, leadership, and the development of new care models,” Suk says.

This focus on efficiency is particularly relevant given the administrative load currently facing the profession. On average, physicians complete 43 prior authorization requests per week, a task that takes valuable time away from direct patient care and contributes significantly to burnout. While artificial intelligence is being integrated into operational areas like appointment scheduling and telehealth to ease this burden, patient skepticism remains a factor. While 60% of patients are comfortable with AI listening and taking notes during a visit, only 28% are comfortable with AI serving as their physician.

Suk says that technology must be used carefully to avoid further fragmenting care. "Primary care continues to evolve toward more collaborative models of care delivery. Physician-led teams supported by advanced practitioners, digital health tools, remote monitoring, and virtual visits can extend the reach of primary care practices and improve patient access," he says. However, some caution is warranted. "These innovations work best when they reinforce continuity and coordination rather than fragmenting care. New care models should strengthen those relationships while expanding the tools available to care for patients across increasingly complex healthcare needs.”

The call to physician advocacy

The future of the profession depends on physician involvement at the policy level. Suk says that physicians play a crucial role.

"Physicians bring a practical perspective to policy discussions because they experience the realities of health care delivery every day. Advocacy allows physicians to contribute that perspective in conversations that shape the future of health care," Suk says.

He notes that participation can take many forms, from engaging with professional organizations like the AMA to communicating directly with policymakers about the challenges facing frontline practices. "When physicians participate in those conversations, the resulting policies are more likely to reflect the needs of both patients and clinicians," he says.

Shaping the next era

The primary care sector is at a crossroads. Success in the next era of health care will belong to those who can balance workforce realities, patient expectations, and responsible AI adoption.

For physicians, this means evolving from traditional roles into leaders of collaborative care teams and active participants in health care policy. By prioritizing professional development, seeking strategic career support, and advocating for systemic financial reform, physicians can ensure that primary care remains the essential foundation of the American health care system.

While workforce shortages and financial constraints are daunting, the shift toward value-based care and team-based models offers a blueprint for a more resilient future.

“Long-term relationships between patients and their physicians remain one of the most powerful elements of effective primary care,” Suk says. “New care models should strengthen those relationships while expanding the tools available to care for patients across increasingly complex health care needs.”