The Power of Primary Care to Improve Health

The Impact of Primary Care

Family medicine emerged in the 1960s due to the need for holistic, person- and community-centered care to counter hyper-specialization and pathology-focused trends in medicine.⁴ The specialty is the cornerstone of primary care, a counterculture movement away from fragmented care in mainstream medicine, and the key to delivering whole-person care.⁵ Despite public perceptions of primary care, indisputable data of the benefits of primary care on health, and a clear roadmap to high-quality primary care provided by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2021 and subsequent reports (Table 1), the U.S. spends under 5% of total health expenditures on primary care.⁶ Yet it continues to have higher health care costs, more chronic disease, and lower life expectancy than peer nations.^7–10

The benefits of having continuous primary care are well studied and include the following¹¹:

• Increased screening to prevent chronic disease in adults (96% with primary care versus 68% without primary care),

• Decreased emergency department (ED) visits and hospitalization in adults (by 11% and 20%, respectively)

• Reduced ED visits and hospitalization in children with chronic disease (by 50%),

• Lowered cost of care for chronic disease in adults and children (by 54% and 40%, respectively).

Primary care physician density in the population is associated with improved mortality and reduced health disparities.^12,13 Patients who see primary care physicians report receiving more high-value care (such as cancer screening), better access to care, and better overall experience.¹⁴ The beneficial impact of primary care on population health likely reflects the core functions of primary care, including continuous relationships, whole-person care, better access, better quality, a greater focus on prevention, more appropriate and cost-effective testing, and early management of medical issues.¹³ Yet there is little emphasis on these core principles and continuous care in the quality measures to evaluate health care.¹⁵

Primary care physicians remain scarce, leaving too many Americans without a usual source of care. While data from 2023 shows a stable workforce of 67 primary care physicians per 100,000 population, other countries with better health outcomes average 80 per 100,000.¹ Lack of access to primary care results in delayed attention to acute and chronic medical conditions as well as less preventive care delivery.¹⁶ Fewer primary care physicians in rural areas, where the combination of travel distance and a lack of broadband internet leads to even longer delays and less overall access, amplifies disparities.^17,18

A lack of primary care also has financial implications, leading to more emergency department utilization, hospitalizations, and specialty care resulting in increased overall health care costs.¹⁹ An analysis of Veterans Health Administration data estimated that each primary care visit could result in more than $700 in cost savings in health care.²⁰ Communities with less access to primary care experience greater health disparities, further compounding poverty and social determinants of health.^21,22

Barriers to a Strong Primary Care Workforce

The reasons for the shortage of primary care clinicians in the U.S. are multifactorial and complex.

First, the financial model of health care in the U.S. does not support a healthy primary care workforce. Further, none of the dominant payment models adequately recognize the breadth and complexity of primary care nor support the financial sustainability of primary care practices. Long-standing reimbursement disparities within the fee-for-service model reward utilization over outcomes, and value-based care shifts financial risk and administrative burden onto clinicians.²³ Direct primary care, while enhancing relationships with patients and liberating physicians from payer constraints, limits access for patients without financial means. The federal government has supported a variety of different models of care, but these investments have fostered mixed patient outcomes.²⁴

Second, not enough medical students are electing to pursue residency training in primary care specialties. A study of residency graduates from family medicine, internal medicine, and pediatrics programs reported that 97% of family medicine residents remained in primary care, while the vast majority of the other specialties did not.²⁵ Additionally, most advanced practice providers do not continue in primary care, choosing to work in specialty care instead.^1,26,27 Several factors divert medical student interest away from primary care. The compensation is lower than for other specialties, compounded by specialty disrespect and the fact that many students graduate with a large amount of debt.²⁸ In clerkships, students encounter primary care preceptors burdened by excessive documentation and administration tasks.²⁹ In addition, as the primary care workforce ages, more people are retiring, leaving primary care, or reducing their clinical hours. The job has become untenable due to increasingly complex patients and more administrative burden.

Third, funding has decreased for both technology to support primary care practice and research to improve it. The development of electronic health records (EHRs) almost 20 years ago was supposed to save time but has instead made documentation more cumbersome. Artificial intelligence that supports, not supplants, the core tenets of primary care by enhancing patient relationships and trust is needed.³⁰ Research to determine improved ways of caring for patients is essential, yet investment in family medicine research is low. Although the largest percentage of health care happens in primary care offices, the National Institutes of Health and other federal funding agencies have awarded less than 1% of grants and funding for primary care research for more than two decades.^31–35

The Way Forward

Given the known benefits of primary care, the detrimental health effects of shortages, and the current barriers, where do we go from here? The 2026 report “Investing in Primary Care: The Missing Strategy in America’s Fight Against Chronic Disease” reiterates the need for greater financial investment in primary care (Table 1).¹¹ This investment can support teams to provide whole-person-centered care, engaging patients as partners in their own health and well-being, ultimately reducing health disparities and chronic disease. Payment reform can compensate primary care clinicians as leaders of the team, reduce burnout, allow flexibility in the scope of work across full-spectrum family medicine, and free physicians to create a modern continuity model that is both fulfilling and rewarding. Investing in primary care research can ensure that care models are truly improving health outcomes. Investing in primary care technology can ensure that AI supports effective and safe care. Family medicine physicians, educators, and researchers need to stay informed of policy and payment changes; communicate with and advocate for our patients on these issues; encourage students to enter primary care; speak out at meetings in our institutions, health systems, and communities; contact local, state, and federal officials and/or support our colleagues who are doing this work (Table 2). As clinicians, educators, researchers, community members, and patients, we need to return to the core principles of family medicine and demand that health organizations and political entities refocus resources to the services that will serve the American public the best.