US Trends in Lacking a Personal Doctor, by Educational Attainment, 2016–2023

Background

Having a regular source of health care is foundational to primary care, with downstream benefits for preventive services, chronic disease control, and lower utilization of emergency care.^1,2 Educational attainment was selected as a focus for this analysis because it is a well-established social determinant of health, strongly associated with health literacy, insurance coverage, and the capacity to navigate healthcare systems.³ These factors collectively influence access to primary care and are consistently measured in national surveillance data. Using publicly available national estimates from the State Health Compare tool (SHADAC), we assessed trends in the share of US adults reporting no personal doctor and examined disparities by educational attainment, an equity lens directly relevant to family medicine.

Methods

We used SHADAC’s “Percent of adults with no personal doctor” measure derived from the Behavioral Risk Factor Surveillance System (BRFSS) public-use files.⁴ National estimates represent the civilian, noninstitutionalized adult population (18+ for the total series; education breakdowns apply to adults 25+). For education, we analyzed four categories available across years: less than high school, high school graduate, some college/associate’s degree, and bachelor’s degree or higher. The SHADAC “no personal doctor” measure is based on self-reported survey responses to the Behavioral Risk Factor Surveillance System question: “Do you have one person you think of as your personal doctor or health care provider?” Respondents answering “no” are classified as lacking a personal doctor. We combined SHADAC export files for 2016-2023; SHADAC reports margins of error (MOE) at the 95% level. Per SHADAC technical notes, 2021 national estimates exclude Florida, and 2023 national estimates exclude Kentucky and Pennsylvania due to insufficient data. All analyses were descriptive; no inferential or significance testing was performed. Analyses rely on public, de-identified, aggregate data and are exempt from human subjects review.

Results

Nationally, the share of adults without a personal doctor fell from 21.9% (2016) to 17.1% (2023) (absolute change −4.8 percentage points; relative change −21.8%). Educational gradients were large and persistent (see Figure 1). Among adults with less than a high school education, rates were highest throughout, from 31.7% (2016) to 30.8% (2023) (absolute change −0.9 percentage points). Adults with a high school diploma who lacked a personal doctor decreased from 20.4% to 17.7% (−2.7 percentage points). Those with some college/associate’s degree without a doctor decreased from 17.3% to 12.8% (−4.5 percentage points). The lowest levels were among adults with a bachelor’s degree or higher, improving from 15.2% to 9.7% (−5.5 percentage points; −36.0% relative change). In 2023, the gap between “less than high school” and “bachelor’s degree or higher” was approximately 21.1 percentage points (30.8% vs 9.7%). A temporary dip in “lacking a personal doctor” was observed across all education groups in 2021, with partial rebound by 2022-2023.

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Figure 1. Trends in Lacking a Personal Doctor by Educational Attainment—United States, 2016-2023

Percentage of US adults reporting no personal doctor, stratified by educational attainment (less than high school, high school graduate, some college or associate’s degree, and bachelor’s degree or higher), 2016-2023. Estimates come from the State Health Compare (SHADAC) measure derived from Behavioral Risk Factor Surveillance System (BRFSS) public-use files. Education categories apply to adults aged 25 years and older. National estimates exclude Florida for 2021 and Kentucky and Pennsylvania for 2023 because of insufficient data, per SHADAC technical documentation. All values represent weighted national estimates; margins of error (MOE) correspond to 95% confidence intervals.

Discussion

From 2016 to 2023, the proportion of US adults reporting no personal doctor declined overall, yet substantial educational disparities persisted, with adults lacking a high school diploma about three times as likely as college-educated adults to report no personal doctor in 2023. These gaps likely reflect intersecting barriers, including lower health literacy, limited insurance continuity, reduced job flexibility for medical visits, and fewer local primary care options, such as fewer clinics in low-resource neighborhoods and limited provider networks in areas with higher rates of low educational attainment. These gradients mirror broader social determinants patterns and align with evidence that educational attainment is associated with health literacy, stable coverage, and navigation capacity.^5,6

For family medicine, these findings have practical implications: practices serving populations with lower educational attainment may require greater resources for patient outreach, care navigation, and insurance literacy support. Embedding care managers or community health workers, standardizing usual-source-of-care assessments during intake, and leveraging team-based continuity may help narrow access gaps. National demonstration projects, such as CPC+ and ACO REACH, may further support care coordination and outreach in underserved groups.

The temporary dip in 2021 was observed across all education groups, with partial rebound by 2022-2023, and may reflect pandemic-related care disruptions, shifts in insurance coverage, or survey response patterns.⁵ Continued monitoring is warranted as states unwind continuous coverage provisions and as workforce constraints evolve.⁷

Limitations

BRFSS is self-reported and cross-sectional; causality cannot be inferred. The measure captures having a personal doctor (usual source), not the quality or continuity of that relationship. SHADAC notes that Florida is excluded in 2021, and Kentucky and Pennsylvania in 2023 from national aggregates; MOE indicates sampling variability. Finally, education captures one sociodemographic axis; other disparities (race/ethnicity, rurality, coverage type) merit complementary analysis. No formal statistical testing was performed, consistent with the descriptive focus of this analysis.

Conclusion

Despite overall improvement in national access, the persistent 21-point education gap in 2023 underscores the urgent need for equity-focused interventions in primary care. Family medicine can target navigation, outreach, and continuity interventions toward populations with lower educational attainment while advocating for payment models that sustain this work.