The Health of US Primary Care: 2025 Scorecard Report
Critical measures of primary care performance nationally and across all states show primary care in crisis, and clear evidence-based solutions to fix it.
Patients in the United States are frustrated with their health care, despite living in a nation with the highest GDP investment in health care in the world. Primary care has the capacity to enhance life expectancy, improve health outcomes, and lower health care costs. However, years of neglect and chronic underinvestment by the health care system have left primary care in a position where it is increasingly unable to meet patients’ needs, particularly in rural and other underserved communities.
This year, our scorecard report spotlights the downward cycle of financing for primary care, and how these systemic financial issues not only undermine the effectiveness of primary care delivery but, more importantly, jeopardize the overall health of our communities.
How Chronic Underinvestment in Primary Care Is Failing US Patients
Declining investment and fee-for-service payment are hindering primary care clinicians’ ability to meet growing patient needs.
Key scorecard findings:
- In 2022, primary care accounted for less than 5% of total U.S. health spending, with spending on Medicare falling to 3.4% and Medicaid to 4.3%.
- Fee-for-service reimbursement models reward procedures over comprehensive care, and undervalue the primary care workforce. In 2022, the average reimbursement for a primary care visit was $259, compared to $1,092 for a gastroenterology visit.
Primary care clinician shortages worsen access to care.
Key scorecard findings:
- The number of primary care clinicians, including physicians, nurse practitioners (NPs), and physician assistants (PAs), decreased from 105.7 per 100,000 people in 2021 to 103.8 per 100,000 in 2022.
- The percentage of NPs and PAs in primary care dipped to new lows of 30% and 24.3% in 2022, respectively, compared with 34% and 29.7% in 2021.
- More than 30% of U.S. adults lacked a usual source of care in 2022—marking the highest level in a decade, despite historically high rates of insurance coverage during this period.
Key scorecard findings:
- Hospital-based graduate medical education (GME) receives significantly more funding than community-based programs, a disparity linked to fewer new primary care physicians entering the workforce.
- The rate of new primary care residents has remained stagnant at 17 per 100,000 people, even as residency slots in other specialties have grown.
- In 2022, only 24.4% of new physicians entered primary care—or 19.8% when excluding those practicing in hospitals—marking the lowest rate in a decade.
Key scorecard findings:
- EHRs, as currently designed and implemented, continue to be a burden for primary care practices, with almost half of family physicians rating EHR usability as poor or fair in 2023.
- Lack of investment in primary care is stalling innovations that could make technology more useful.
Key scorecard finding:
- The federal research investment in primary care remains well below 1%, although spending increased marginally from 0.31% of total federal health care research budget in 2022 to 0.34% in 2023.
An Inside Look at the Scorecard
Take a closer look at scorecard findings by exploring Milbank Memorial Fund's dashboard tools and a recorded webinar.
Milbank: 2025 Scorecard Data Dashboard
This dashboard measures key primary care indicators over the past decade for the nation and across states as the data were available.
Milbank: 2025 Primary Care Scorecard Webinar
This webinar highlights how the nation and states are performing on primary care workforce, financing, and research funding measures.
Scorecard in the Media
Stay up to date on the latest news and media outlets referencing the 2025 scorecard.