Young adults are slipping away from primary care, and they aren't the only ones

The primary care relationship, long treated as a fixed feature of American medicine, is thinning on two fronts for the country's youngest adults: They are less likely to have a physician at all, and even when they do, most are not walking through the door.

A national poll commissioned by The Ohio State University Wexner Medical Center found that just 71% of adults ages 18 to 29 have a primary care physician, compared with 97% of adults 65 and older. Among the younger adults who do have one, fewer than half said they had a checkup in the past year. The survey of 1,006 adults was conducted on SSRS's Opinion Panel Omnibus in early May, 2026.

For physicians, the worry is less about a single missed visit than about everything a missed visit hides. "My young, healthy patients might be the picture of health, but they might not know they're behind on their tetanus shot because it's been 10 years," said Zachary Bittinger, M.D., a family medicine physician and clinical assistant professor in Ohio State's Department of Family and Community Medicine. "They might not know that it's time for their first Pap test. There are lots of things that crop up that we see coming in primary care from a long way away."

Why young adults are choosing urgent care over a primary care physician

When something does go wrong, younger patients increasingly route around primary care entirely. The Ohio State survey found that 36% of young adults would visit an urgent care clinic first for a non-emergency problem, while 68% of older adults would contact their primary care physician.

Andrea Giamalva, M.D., chief medical officer at Experity, an on-demand care technology company, told Medical Economics that trend is indicative of a generational shift. She said market data shows the share of patients without a primary care physician rising steadily with each younger cohort: roughly 10% of baby boomers, about 20% of Generation X, around 30% of millennials and close to 40% of Generation Z.

The result is that urgent care has become the “front door to health care for many Americans," with patients arriving for far more than coughs and sprains. "We're living in what we'll call the Amazon-Uber-DoorDash world," Giamalva said. "It's maybe the first time that health care is actually stepping up to the demands of the culture."

A family medicine physician who spent 11 years managing a panel of nearly 3,000 patients, she argues urgent care can ease the strain if patients are matched to the right setting, with straightforward visits handled on demand and complex, chronic patients kept in a continuous primary care relationship.

Primary care physicians see the same shift from the other side, and not always as relief. Yalda Jabbarpour, M.D., a family physician and vice president and director of the Robert Graham Center, said the proliferation of urgent care, telehealth and other on-ramps is a symptom of a system that has made it too hard to get in the front door, and that the workarounds can multiply visits rather than replace them.

"A lot of times when my patients can't see me and they need to see me, then they end up going to urgent care. They may get something answered, but they don't get everything answered, and so they end up seeing me anyway," she told Medical Economics earlier in a February discussion. "So that's two visits when it could have been one." She added a workforce concern: urgent care clinics are themselves staffed largely by primary care clinicians, which pulls them away from longitudinal practice.

Related content: The primary care crisis, by the numbers, with experts from the Milbank Memorial Fund, the Physicians Foundation and the Robert Graham Center

How many Americans don't have a primary care physician?

Young adults are the sharpest edge of the trend, but the erosion runs well beyond them. The 2026 U.S. Primary Care Report, produced by the Robert Graham Center and co-funded by the Milbank Memorial Fund and The Physicians Foundation, found that nearly one-third of adults lack a usual source of primary care, and that less than 5% of total U.S. health care spending goes to primary care at all.

Morgan McDonald, M.D., national director for population health at the Milbank Memorial Fund and a co-author of the report, explained that "almost a third of US adults and 12% of kids go without a usual source of primary care."

A 2023 report from the National Association of Community Health Centers estimated that more than 100 million Americans — nearly one-third of the nation — are "medically disenfranchised," meaning they may not be able to reach primary care because too few clinicians practice in their community. That figure has nearly doubled since 2014, when it stood at 56 million. Only 1 in 10 of those people are uninsured, a sign that the gap is driven by a shortage of physicians rather than a lack of coverage.

Before that, a 2019 KFF analysis found that 45% of adults ages 18 to 29 lacked a primary care physician, compared with about 25% of adults overall — a larger gap than the latest Ohio State numbers, but pointing in the same direction across surveys.

What's causing the primary care physician shortage

Behind the access numbers is a workforce problem decades in the making. In a 2024 review in The American Journal of Medicine, Edward P. Hoffer, M.D., of Harvard University, noted that only 24.4% of U.S. physicians now practice in the primary care specialties of family practice, general internal medicine and pediatrics, against a ratio of 50% widely considered ideal. In 1931, more than 75% of American physicians were generalists. The pipeline is not refilling fast enough to reverse that.

McDonald said only 1 in 5 physician trainees now enters primary care, a figure roughly matched among physician associates and reached by only about a third of nurse practitioners. The Association of American Medical Colleges has projected a shortage of between 21,400 and 55,200 primary care physicians by 2033.

Ask primary care clinicians to describe the state of the field and the words turn grim. McDonald said most, herself included, would use the word “threatened." Jabbarpour said simply that primary care is "suffering and need[s] more support."

And the strain is self-reinforcing, said Dhruv Khullar, M.D., a practicing physician and associate professor of health policy and economics at Weill Cornell Medical College who directs the Physicians Foundation's Center for the Study of Physician Practice and Leadership.

"It just seems to be harder to practice primary care in this country year after year," Khullar said, "and so unless we make substantial changes to how health care is financed, how administrative burden influences people's desire to go into primary care or stay into primary care... I worry that the health of the primary care workforce is going to take a hit."

Why fewer physicians choose primary care: Pay, debt and paperwork

A lot of the pressure starts with money. Hoffer's review reported that the average U.S. primary care physician earned about $260,000 in 2022, while the average specialist earned $368,000, a gap that lands hard on graduates carrying a median medical school debt near $200,000. Compounding it is a fee structure, set through the American Medical Association's procedural coding committees and dominated by specialists, that has long valued procedures over the diagnosis, counseling and prescribing that define primary care.

The day-to-day work has grown heavier, too. A 2022 simulation study in the Journal of General Internal Medicine estimated that delivering every guideline-recommended service to a typical patient panel would take a primary care physician 26.7 hours a day, including 14.1 hours of preventive care alone and more than three hours of documentation and inbox management.

For the analysts behind the primary care report, the deeper problem is not only how little goes to primary care but how it is paid. "We're only getting five cents on the dollar. That's not enough to support all those team members in a primary care office," Jabbarpour said, arguing that fee-for-service billing fails to cover the after-hours calls, portal messages and team-based work that make up modern primary care.

Debra Lubar, Ph.D., president of the Milbank Memorial Fund and a former chief operating officer of the Centers for Disease Control and Prevention, explained that only about 5% of health care dollars go to primary care, even though it makes up approximately 40% of the services provided. “That really needs a rebalancing," she said, stressing that the call isn;t for more total spending, but for a rebalancing. "We're talking about really balancing those payments so that primary care is incentivized."

Why insured patients still can't afford primary care

Survey data from the Urban Institute found that 46% of working-age adults reported at least one health care affordability problem in 2025, and physicians say the squeeze is reshaping their patient relationships. In athenahealth's fifth annual Physician Sentiment Survey, 52% of physicians named patient affordability the most pressing policy issue facing the profession, a 14-point jump in two years that pushed it past administrative burden for the first time.

Related content: Nearly half of your patients struggled to afford care in 2025

That shift is colliding with the expiration of enhanced Affordable Care Act premium tax credits at the end of 2025 and Medicaid changes under the One Big Beautiful Bill Act, both expected to push more patients out of coverage.

"Physicians love their patients. Just not being able to see them because they don't have insurance is quite heartbreaking," Brian Outland, Ph.D., of the American College of Physicians, told Medical Economics.

Nele Jessel, M.D., chief medical officer at athenahealth, pointed to how little room practices have to absorb the fallout. "Only 32% of physicians in our most recent survey expressed optimism for the future of U.S. health care," she said. "That makes me, personally, very concerned."

The pediatric-to-adult care transition gap for young adults

For young adults specifically, much of the detachment can be traced back to the move from pediatric to adult primary care. The transition typically happens between ages 18 and 21, when patients become responsible for their own appointments, prescriptions and insurance, often without structured support from the systems they are leaving.

"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, a clinical social worker and director of transitional care support at Boston Children's Hospital. "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."

A study published in the Journal of Pediatric Nursing reached a similar conclusion, finding that many young adults felt "lost" 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.

How social drivers of health affect primary care access

Even where physicians are available and patients are insured, the conditions that drive people to need care, or keep them from seeking it, often sit outside the exam room. The Physicians Foundation has built much of its recent work around what it calls the drivers of health: food security, housing stability, transportation access, utilities access and interpersonal safety.

Paul Harrington, a board member of the foundation and former executive vice president of the Vermont Medical Society, illustrated the stakes with a single county. In one ZIP code near Jupiter Beach in affluent Palm Beach County, Florida, he said, life expectancy runs about 83 years; in another roughly 10 miles away, it falls to about 67. "A difference of about 16 years, 10 miles apart," Harrington said.

Khullar, who helps lead the foundation's research, said social factors shape outcomes "much more than the medical care that's being delivered in clinics and hospitals," yet the health system is far better at flagging those needs than meeting them. Screening for social risk, he said, "often doesn't go a very long way" when the community lacks the food, housing or transportation resources to act on it. The gap takes a toll on clinicians too.

Physicians, Khullar said, "feel a degree of... moral injury when they are not able to meet a need of a patient that is clearly leading to adverse health consequences."

What patients lose without a usual source of primary care

The case for closing it rests on what primary care prevents. The 2026 U.S. Primary Care Report found that for adults with chronic disease, a usual source of primary care was associated with a 20% lower likelihood of any hospitalization, an 11% lower likelihood of an emergency department visit and nearly 54% lower total health care costs.

Among adults with a usual source of care, 95.5% received key preventive services for conditions such as heart disease and common cancers, compared with 67.6% of those without one. For children with chronic disease, the report found the benefits were larger still.

To Jabbarpour, the most telling result was about trust as much as access. Cardiovascular screening happens during a primary care visit, she noted, but cancer screening usually does not. "These don't actually happen in the primary care office. You see your primary care physician, you get counseling on it, they give you a referral," she said. "The fact that that completion was higher for people who had a primary care physician than those that didn't was a little bit surprising, because it takes an extra step. That just speaks to the trust that is developed when you have a primary care physician." Prevention, she added, is the point. "That might be a new agenda, but prevention is nothing new for primary care. It is the cornerstone of primary care."

Hoffer's review cited research estimating that one additional primary care physician per 10,000 people was associated with a 5.3% reduction in mortality, and separate work tying each additional primary care physician per 10,000 to roughly 51 added days of life expectancy, compared with about 19 days for an additional specialist.

Why patients turn to AI and social media for health information

When patients lack a clinician to call, many turn elsewhere for answers. A recent KFF tracking poll found that 29% of adults now use artificial intelligence (AI) tools or chatbots for health information at least monthly, nearly double the share two years earlier, and that 31% turn to social media. That migration carries a cost physicians are only beginning to see in their exam rooms.

A companion KFF poll found that adults who lack a clinician they trust were nearly twice as likely to believe vaccine misinformation, and that people who rely on social media or AI for health information were consistently more likely to endorse false claims about vaccines.

Physicians describe the relationship itself as the antidote. A usual source of care "reduces misinformation and helps people trust the advice that they're getting," said Ripley Hollister, M.D., a family physician and board member of The Physicians Foundation.

According to McDonald, roughly 80% of people treat their primary care clinician as the source they trust most for decisions about food, child safety and vaccination. The exam-room relationship, in other words, is not only a vehicle for screenings and prescriptions. It is an information anchor, and its absence leaves room for something less reliable.

How to close the primary care gap

The fixes most often proposed run through reimbursement and time. Hoffer argued that payers, including Medicare and Medicaid, should narrow the income gap by paying more for cognitive services, that administrative and electronic health record burdens must be cut through a kind of "digital minimalism," and that practices should be reorganized around teams so physicians can focus on complex care while documentation shifts to scribes or AI-assisted transcription.

Jabbarpour and others would go further, carving primary care out of fee-for-service entirely. "There have been calls for this by big thinkers in primary care, to almost carve primary care out of the entire health care spend," she said, describing a model that would allocate a fixed share — perhaps 10% — to cover whatever care a population needs, whether a visit, a nurse's call or a portal message.

Other levers are more immediate. Community health centers, the National Association of Community Health Centers found, already keep 15 million additional patients attached to a usual source of care, and Lubar pointed to recent federal funding for them as part of the policy toolkit.

Workforce policy rounds out the picture, from recruiting more medical students from rural and lower-income backgrounds to expanding loan repayment for clinicians who practice in underserved areas. For Khullar, the obstacle is less evidence than resolve. Adequate investment in primary care and in patients' social needs, he said, carries "an enormous ROI that... just require[s] the social and political will to implement."

None of it changes the basic math facing the physicians who remain. The people best positioned to close the primary care gap are the same ones being squeezed out of it by economics, administrative load and shrinking visit times. And for the youngest patients, the cheapest intervention is also the simplest: getting them attached to a primary care physician before a crisis makes the introduction for them. As Bittinger put it, primary care is built to see problems coming "from a long way away."

The trouble is how many young adults are no longer in the room to be seen.