Fewer clinicians entering primary care: 5 report card findings

The report, “The Health of US Primary Care: 2025 Scorecard Report — The Cost of Neglect,” points to underlying challenges contributing to a lack of access to primary care in the U.S., including insufficient funding and reimbursement rates. This marks the third edition of the scorecard report, led by researchers at the AAFP’s Robert Graham Center for Policy Studies in Primary Care. The report is co-funded by the Milbank Memorial Fund and The Physicians Foundation and is based on national and state-level data tracking primary care performance, workforce trends and reimbursement patterns.

Here are five key findings from the report: 

1. Payer spending on primary care continued to drop in 2022. Overall, primary care spending was under 5%, falling most among Medicare and Medicaid, down to 3.4% and 4.3%, respectively, compared to the last scorecard report.
2. Revenue disparities hinder the field’s ability to attract new clinicians, according to the report. Reimbursement rates in 2022 for a primary care visit averaged $259, relative to $1,092 for a gastroenterology visit.
3. The number of primary care physicians, physician associates and nurse practitioners fell from 104.7 per 100,000 in 2021 to 103.8 per 100,000 in 2022. Meanwhile, the percentage of advanced practice providers in primary care hit new lows in 2022; 30% of NPs were in primary care and 24.3% of PAs were in the field. The decline indicates a growing portion of clinicians are choosing to work in higher-paying specialties. 
4. In 2022, 24.4% of new physicians entered primary care, marking the lowest rate in a decade. When excluding hospitalists, this figure was 19.8%.  A major factor limiting the pipeline is the imbalance in graduate medical education funding, which disproportionately supports hospital-based training over community-based programs, according to the findings. The report notes that despite demand for more primary care clinicians, the number of new primary care residents has remained stagnant, as fewer trainees receive early exposure to outpatient primary care settings.
5. Competitive pay and enabling primary care clinicians to have more autonomy over their practice through care delivery redesign efforts are two key ways to attract more physicians and APPs to the field, researchers said. 

“Beyond pay, PCPs need agency,” Christopher Koller, president of Milbank Memorial Fund, told Becker’s. “The demands on primary care are growing, and too often, feel out of physicians’ control. Health systems must engage primary care doctors in care redesign efforts instead of just adding to their workload. Failure to do so will make the unionization efforts we have seen grow more common.”

Yalda Jabbarpour, MD, lead report author and director of the Robert Graham Center, said systems should offload administrative tasks through team-based models and technology investments. 

“Too often, primary care clinicians are bogged down with routine administrative tasks like medication refills, basic portal messages, and paperwork — tasks that could be handled by other team members or technology,” he said. “Health systems should shift these responsibilities so clinicians can focus on what they do best: caring for patients.”

“Because primary care serves patients of all ages with a wide range of health needs, a  one-size-fits-all approach to patient visits simply doesn’t work. Clinicians need the flexibility to determine the right approach — whether that’s a quick phone call or a 45-minute in-depth visit — rather than being forced into rigid structures that contribute to burnout and patient frustration.”