Primary care shortfall has ripple effects throughout U.S. health care system
Spending on primary care fell from an average of 6.2% in 2013 to 4.6% in 2020.
“High-tech health care grabs the headlines, but high-touch, personalized primary care with tech support keeps people healthier at a lower cost,” said Ann Greiner, president and CEO of the collaborative. “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.”
The nation has seen a consistent decrease in the number of primary care clinicians since 2014, caused by a decline in the number of physicians entering primary care, burnout leading to retirement and decreased direct patient care time, the report said. In 2019, there was a net loss of 10 clinicians per 100,000 people across the United States. Spending on primary care fell from an average of 6.2% in 2013 to 4.6% in 2020.
Having access to a regular source of primary care is associated with fewer emergency department visits and hospitalizations; lower odds of dying prematurely; and lower health care costs. However, one-fourth of Americans currently do not have a relationship with a primary care clinician, and 40% of adults in the United States failed to have a primary care visit in 2019. These trends have been exacerbated by the COVID-19 pandemic, suggesting that the situation may be more dire than the report’s data reflect.
Experts recommend a multifaceted approach to rebuilding primary care that outlines steps policymakers, providers and employers can take, including:
- Offering more primary care training opportunities and incentives for clinicians to select primary care as a specialty;
- Collecting accurate and transparent workforce and primary care financing data;
- Establishing a hybrid primary care payment option alternative to fee-for-service for accountable care organization in the Medicare Shared Savings Program and more broadly across public and private programs;
- Crafting solutions to mitigate the primary care barriers of high-deductible health plans, and
- Supporting today’s primary care workforce by lowering administrative burdens and building diverse teams to address the range of patient primary care needs.
Related: Primary care doctors: The ‘quarterbacks’ in a value-based care playbook
“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,” said Dr. Alison N. Huffstetler, medical director for the Robert Graham Center. “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.”