RESEARCH LETTER
James R. Burmeister, BS; Ida J. Rubino, MD
Corresponding Author: James R. Burmeister, BS; Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine
Email: jburmeister@oakland.edu
DOI: 10.3122/jabfm.2025.250314R1
Keywords: Access to Health Care, Behavioral Risk Factor Surveillance System, Continuity of Patient Care, Educational Status, Epidemiology, Health Disparities, Health Services Accessibility, Physician-Patient Relations, Population Health, Primary Health Care, Secondary Data Analysis, Social Determinants of Health, Socioeconomic Factors
Dates: Submitted: 08-10-2025; Revised: 11-08-2025; Accepted: 12-01-2025
Status: In Press.
BACKGROUND: Having a personal doctor is a cornerstone of primary care, associated with improved preventive service use, chronic disease management, and patient satisfaction. Educational attainment is a key social determinant of health and access to care.
METHODS: We analyzed national trends in the percentage of U.S. adults lacking a personal doctor from 2016 to 2023 using the State Health Compare tool (SHADAC) based on the Behavioral Risk Factor Surveillance System (BRFSS). Adults were classified by educational attainment: 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-report: respondents answering “no” to the BRFSS question “Do you have one person you think of as your personal doctor or health care provider?” were considered to lack a personal doctor. Only descriptive statistics were used; no inferential testing was performed.
RESULTS: Nationally, the share of adults without a personal doctor declined from 21.9% in 2016 to 17.1% in 2023 (absolute change −4.8 percentage points; relative change −21.8%). Reductions occurred across all education groups, but disparities persisted. In 2023, 30.8% of adults with less than a high school diploma reported lacking a personal doctor, compared with 9.7% among those with a bachelor’s degree or higher—a gap of over 21 percentage points. Improvements were largest for college-educated adults (−36.0% relative change) and smallest for those without a high school diploma (−2.9%).
CONCLUSIONS: Despite overall improvement, large and persistent education-related disparities remain. Interventions such as care navigation support, insurance literacy programs, and payment models funding outreach may help address these gaps. The persistent 21-point gap highlights the ongoing challenge for equity in primary care access in the United States.