Access to primary medical care is closely associated with better health outcomes for patients, fewer hospital visits, and longer life spans. Yet in the United States, primary care spending for all payers accounted for merely 4.6% to 12.1% of total health care expenditures, depending on how broadly primary care is defined. For the first time, a national scorecard provides a deep dive into where primary care is lacking within a matrix of recommendations.
Supported by the Milbank Memorial Fund and The Physicians Foundation, and prepared by the Robert Graham Center, the new scorecard focuses on:
- Financing: The United States is systemically underinvesting in primary care.
- Workforce: The primary care physician workforce is shrinking and gaps in access to care appear to be growing.
- Access: The percentage of adults reporting they do not have a usual source of care is increasing.
- Training: Too few physicians are being trained in community settings, where most primary care takes place.
- Research: There is almost no federal funding available for primary care research.
The pipeline of workforce development and training programs, in particular, is key to generating a spectrum of primary care clinicians. Delivery of quality, modern care requires a team orchestrated for “the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams that are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.”
Dr. Sunita Mutha, director of Healthforce Center at UCSF, served on the national advisory committee for the creation of the scorecard. Upon its release, Mutha said, “It is noteworthy that we finally have a nationwide data set we can monitor over time that can inform actions. We can use data to decide where to invest precious resources to improve the health of our country.”
Mutha adds, however, her concerns that the national scorecard “is probably the rosiest picture that it can be. I worry for two reasons. We have a workforce that is aging and therefore practicing less. And these data can’t measure burnout. Both issues mean clinicians will practice less and communities have less access to primary care than the data suggest.”
An increased investment in primary care is especially important for the advancement of health equity in the US, as many other data point to shorter lifespans, higher incidence of many chronic conditions, and increased rates of maternal death among Black, Indigenous, and people of color. To turn this tide, we must expand workforce investments that develop members of these communities to provide primary care and support clinicians to serve communities in need.