Access to primary care in the U.S. has worsened over the past decade, and a lack of investment is to blame. This drop in access impacts all Americans, in communities large and small, urban and rural.
Wait times to see a primary care clinician take up to one month on average and are likely much longer for those trying to establish care for the first time. More than 25% of American adults and more than 10% of children have no regular source of care, another statistic that has worsened over the last decade, despite expanded insurance access from the Affordable Care Act and other federal programs. In addition, U.S. life expectancy already lags behind many other developed nations.
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Why are these access issues occurring? The American Academy of Family Physicians' Robert Graham Center — which publishes evidence-based research to inform policies that support family medicine and primary care, and improve population health — authored the 2024 Health of U.S. Primary Care Scorecard, released in February. The second annual report points to several factors restricting access, but the root of the problem is clear: We have a shrinking primary care workforce, and the U.S. continues to underinvest in primary care.
Certainly, solutions such as training more primary care physicians and investing in the workforce through the Teaching Health Center Graduate Medical Education program are essential, but they also take a long time to bear fruit. Despite policy efforts to increase the number of primary care physicians needed to meet increasing demand, primary care physician density has been dropping instead of rising over the last 20 years. The bottom line is that we are not recruiting enough physicians to keep up with our shrinking workforce, in part due to burnout and retirements.
So how could the healthcare system improve access to meet growing patient demand? One partial solution is to expand team-based models. The era of the physician taking on all the tasks and responsibilities for an entire panel of patients is gone, not only due to the rising social and clinical complexity of patients, but also because the ever-multiplying administrative work makes it impossible. Research has demonstrated that high-functioning teams led by a physician reduce clinician burnout, increase access for patients and result in higher-quality care.
Innovative primary care practices throughout the country have already successfully incorporated nonphysicians into their teams — including advanced practice providers such as physician assistants and nurse practitioners, as well as pharmacists, social workers and community health staff — all working with a physician leader to improve access and quality of care. Yet, efforts to make these changes have been slowed by an outdated fee-for-service payment model that fails to consider the full spectrum of care.
As we wait for the payment system in the U.S. to catch up to evidence-based models of care delivery, we must look to the future of healthcare. Advances in technology are moving quickly, and if harnessed correctly can dramatically increase access to high-quality primary care.
While certainly not a replacement for in-person care, innovations such as using artificial intelligence to help with triage and alleviate some of the burden from paperwork can free up physician time spent on the phone or managing patient portals. Ambient listening models that generate high-quality notes will allow clinicians more face-to-face time with patients instead of sitting in front of a computer screen.
AI can also help with appropriate scheduling, so patients get the time they need with their physicians. Using AI to triage patients according to severity of condition will also enable right-sizing of clinician panels and allow for more efficient allocation of visits based on patient need. Digital health coaching for chronic disease also could help reduce routine office visits for things such as hypertension monitoring and diabetes follow-up, freeing up time for new or more complex patients to be seen.
The complexities of today’s primary care system and the proposed policies to create a more functional system have been well documented, and there has been some progress toward achieving these solutions. For example, a number of senators have begun a conversation around providing a prospective hybrid payment for primary care physicians within Medicare.
As leaders in their communities, family physicians are uniquely positioned to advocate for change. Now it is incumbent on our nation’s leaders to act on these proposals and enact policies that will support access to high-quality primary care to improve public health, expand access to care and increase life expectancy.
Dr. Yalda Jabbarpour is director of the American Academy of Family Physicians’ Robert Graham Center for Policy Studies and a family physician in Washington, D.C.
