The Health of US Primary Care: 2024 Scorecard Report

The primary care workforce is struggling to meet population needs.

Despite a rapidly aging population with higher levels of chronic disease, the number of primary care physicians (PCPs) per person has decreased.

Key scorecard findings:

• the share of all clinicians practicing primary care stagnated around 28% between 2016 and 2021,
• PCPs declined from 68.4 to 67.2 per 100,000 people between 2012 and 2021, and
• there has been a 36% jump in the number of U.S. children without a usual source of care over the last decade and a 21% increase among adults.

Demand for PCPs will only increase with time. The National Institute of Health estimates that the number of people 50 or older with at least one chronic disease will increase by 99.5%, from 72 million in 2020 to 143 million by 2050.

The primary care sector is experiencing a workforce exodus and lacks real-world community training opportunities.

Key scorecard findings:

• In 2021, 37% of all physicians in training specialized in primary care, yet only 15% of all physicians were practicing primary care three to five years after residency. The remainder subspecialized or became hospitalists who do not work in community settings.
  
• In 2020, only 15% of primary care residents spent a majority of their time training in community settings (outside of hospitals and academic health centers) — signaling that many residents may lack adequate experience practicing in real-world clinical environments.
• In 2020, fewer than 5% of primary care residents spent the majority of their training in Teaching Health Centers or rural training tracks, two programs that historically serve disinvested communities. Research indicates physicians who train in Teaching Health Centers are more likely to practice in underserved communities.

• The share of total US health care spending devoted to primary care stayed under 5% from 2012 to 2021.
• Since 2019, investment in primary care has steadily declined across all major health care payers; this decline has been most pronounced for Medicare reimbursements for primary care services and providers, which have dropped by 15%.
• The compensation gap between primary care physicians and specialists discourages residents from choosing primary care.

• In 2022, more than 40% of family physicians rated the usability of their electronic health record (EHR) systems as unfavorable. 
• Over 25% reported overall dissatisfaction with their current EHR system. 
• According to the American Board of Family Medicine, 16% of family physicians reported spending four or more hours per day on EHRs, taking time away from patient care.

• Since 2017, only 0.3% of federal research funding per year has been invested in primary care research, limiting new information on primary care systems, delivery models, and quality.
  
• A lack of adequate data on the prevalence of hybrid primary care payment and the training of PAs and NPs, for example, makes it difficult to track progress on the implementation of high-quality primary care.