Primary care scorecard demonstrates serious challenges

March 10, 2025

Summary: Think tank report documents the deep malaise in primary care in the U.S.

Source: Jabbapoor, et al Milbank Memorial Foundation February 18, 2025

The Milbank Memorial Foundation’s 2025 primary care scorecard published last month demonstrates the serious challenges facing primary care. Researchers point to a growing portion of Americans without access to a usual source of care and a decline in physicians and advanced practice clinicians such as physicians and nurse practitioners entering primary care.

The U.S. system of training physicians leads to a growing gap between the number of newly trained physicians going into primary care and those going into specialties. States with more graduate medical education funding had fewer new PCPs than states with less funding, and fewer than one in six (15.9%) of primary care residents spent most of their training in a community-based setting. Over a quarter of family physicians said they were dissatisfied or very dissatisfied with their electronic health records and almost half reported EHR usability to be “fair” or “poor.”

The researchers reported that overall spending on primary care was under 5% of total medical spending in 2022, and primary care spending was just 3.4% of total spending in Medicare and 4.3% of total spending in Medicaid. Average reimbursement per visit was over four times as high in gastroenterology compared to primary care.

Primary Care Physician Spending 2012-2022

Source: Jabbapoor, et al Milbank Memorial Foundation February 18, 2025

Many policy experts suggest that moving away from fee for service payments for primary care could help reinvigorate primary care, and the Milbank researchers say that 9.6% of primary care payment was in population-based payments, up from 4% in 2017. I worry that the literature has shown that paying capitation or population-based payment decreases utilization and access - exactly the opposite of what is needed in primary care. Population payments are more appropriate for low value or overutilized services. Primary care access needs more dollars, not just a different way of being paid.

The rate of primary care clinicians (including physicians, NPs and PAs) continues to gradually decline, even as the aging U.S. population likely needs more primary care.

Primary Care Clinicians per 100,000 population

Source: Jabbapoor, et al Milbank Memorial Foundation February 18, 2025

Here’s a link to previous posts on deteriorating primary care access and the role of advanced practice clinicians.

Implications for employers:

● Primary care shortages will likely continue, and health plan designs that rely on primary care gatekeeping and navigation might have difficulty obtaining adequate coverage

● Virtual care can help primary care clinicians support larger patient panels.

● More elements of primary care, including screening, could be delivered through self-service. Home testing for colorectal cancer is already available, and the FDA will hopefully approve home testing for cervical cancer soon.

● Employers can encourage their carriers to reimburse primary care adequately to maintain access, and to avoid prior authorization and other hassles that frustrate primary care practitioners.

Thanks for reading. You can find previous posts in the Employer Coverage archive

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Tomorrow: Increased health insurance costs lead to lower employee wages