An Open Letter to the Next Administration Regarding Primary Care

As we prepare for a new administration and a new Congress, I’ve been thinking a lot about what I want our new leaders to know about our healthcare system and, more specifically, primary care. By understanding the field, its challenges, and its importance, President-elect Donald Trump and his administration can help give primary care the investment it needs.

First, our healthcare system is not meeting the needs of our population and, as a result, people are increasingly sick. Second, our healthcare system is causing financial strain for individuals, families, employers, and state and local governments. And third, our healthcare system does not protect primary care physicians, who are working tirelessly to meet the unique needs of a diverse and aging population. These challenges result in several dangerous consequences: increasing maternal mortality, falling life expectancy, and a system that is struggling to support both patients and physicians.

I believe these issues are a direct result of our failure to prioritize primary care. The U.S. faces a primary care physician workforce shortage that is already crippling access to care in areas that need it the most. Furthermore, our current payment models undervalue primary care services, discouraging health professionals from choosing primary care. Fewer Americans today report having a relationship with a primary care physician compared to a decade ago. This spells disaster for millions of patients who should be relying on primary care to help manage chronic and acute illnesses, access preventive care like vaccines and cancer screenings, and lower overall healthcare costs.

How did we get here? To start, the U.S. population is aging and so are its physicians. It is estimated that we will need up to 40,400 additional primary care physicians by 2036. Additionally, the number of Americans ages 65 and over will grow 47% by 2050. At the same time, one-third of all currently active doctors will be older than 65 and moving toward retirement within the next decade.

According to a primary care scorecard authored by the American Academy of Family Physicians’ Robert Graham Center, the number of primary care physicians per person in the U.S. has decreased. Between 2012-2021, primary care physicians declined from 68.4 to 67.2 per 100,000 people. And as the health needs of an aging population have increased, the share of all clinicians practicing primary care stagnated at around 28% between 2016 and 2021.

These frustrating and concerning statistics underscore an urgent access and equity issue: primary care physicians cannot keep up with today’s demand. In order to put in motion tangible solutions and proposals that will bolster our workforce, we need the help of policymakers.

To address issues facing both physicians and patients — from clinician burnout to healthcare staffing shortages to lengthy appointment wait times to difficulty finding a physician — we need to address the root causes of the problems: historic underinvestment in primary care and flawed payment systems. Primary care accounts for 35% of healthcare visits in the U.S., yet represents just 5%-to-7% of total healthcare expenditures.

Many factors influence a medical student’s decision to practice primary care. However, we know that the practice environment (e.g. workforce shortages, underinvestment in the field, etc.) and lower pay compared to other specialties are disincentives to many who might otherwise consider the field.

I have read many “obituaries” about the decline of primary care. But in my opinion, it has never been a better time to invest in the field. I challenge President-elect Trump and Congress to prioritize health outcomes and financial security through major investments in primary care. This includes increasing our national investment in primary care and ensuring we have a robust primary care workforce for generations to come, improving the practice environment by eliminating the administrative complexities that come between patients and physicians, and ensuring that every individual in every community has access to a family physician and a trusted medical home.

I don’t want to imagine what a world without primary care looks like, and neither should our nation’s leaders. If our new president and the 119th Congress is truly looking to create a healthier country and economy, then investing in primary care and solidifying its role as the anchor of our healthcare system is the way forward.

R. Shawn Martin, MS, is executive vice president and CEO of the American Academy of Family Physicians.

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