Reestablishing Trust in Primary Care: A Demand for Investment and Reform

By Vineeth Amba, Archita Goyal, and Wayne Altman, MD

As first-year medical students, many of us stepped into medical school with a strong sense of purpose and an idealistic outlook on what it meant to be a primary care physician (PCP). We aimed to cultivate long-lasting relationships with patients, support our communities, and provide caring, top-quality service. We pictured ourselves as reliable healers addressing the social and structural obstacles that frequently hinder patients from accessing necessary care.

However, during our clinical rotations, the passion that previously fueled our aspirations began to decline. We were met with discouraging remarks from physicians across various specialties — including those in primary care: “Don’t pursue it.” “It no longer resembles what it was.” “You can’t obtain the necessary support to adequately care for patients anymore.”

This was disheartening.

These views represent a grim truth. American primary care is not merely facing challenges—it is undergoing a crisis. Both patients and providers are feeling the repercussions. Yet there is optimism: heightened investment in primary care could potentially reverse this trend and rejuvenate a vital pillar of our healthcare system.

The Current Status of Primary Care

Primary care forms the backbone of an effective healthcare system. It enhances outcomes, boosts access, and lowers costs. Yet, despite its significance, primary care is critically underfunded and undervalued in the United States.

Presently, only 25% of physicians engage in adult primary care, and this figure keeps declining. Several factors contribute to this trend:

– An aging workforce and premature retirements
– Alarming rates of physician burnout
– Insufficient support for primary care practices
– Compensation far behind that of other specialties

Even before the onset of the COVID-19 pandemic, a study published in the Journal of the American Board of Family Medicine revealed that nearly 75% of primary care physicians faced burnout. By 2036, the nation is projected to encounter a deficit of 68,000 full-time equivalent PCPs.

This shortfall has serious consequences for both population health and health equity. From 2012 to 2021, the percentage of children lacking a regular source of care surged by 36%. For adults, it increased by 21%. Currently, around 100 million Americans do not have consistent access to primary care.

Highlighting State-Level Initiatives

Acknowledging the urgency of the situation, some states have begun implementing measures.

– Delaware mandates that Qualified Health Plans engage in quality improvement workgroups to enhance care coordination and adopt patient-centered medical home (PCMH) models.
– Rhode Island requires insurers to invest in PCMH practice support payments—an initiative that has improved infrastructure and care quality.
– Oregon promotes integrated behavioral health through Coordinated Care Organizations (CCOs) and Patient-Centered Primary Care Homes.

Even Massachusetts, a frontrunner in health reform, encounters significant obstacles. One-third of PCPs in MA are over 60 years old, and only 5% of medical school graduates from 2023–2025 intend to pursue family medicine. These patterns jeopardize the state’s capability to maintain a strong primary care workforce.

The Imperative for Immediate Investment in Primary Care

Research consistently indicates that robust primary care systems yield:

– Superior population health outcomes
– Augmented access to care for underserved populations
– Decreased overall health care expenditure

Yet while primary care accounts for 35% of patient visits, it receives only 5–7% of health care spending.

The California Health Care Foundation discovered that states with higher primary care expenditures enjoyed improved care quality, enhanced patient experience, diminished hospital utilization, and reduced overall costs. When primary care is underfunded, it undermines its capacity to provide value and deteriorates the essential relationships that make this profession so influential.

The time has come to alter our trajectory—not through minor reforms but through bold, comprehensive transformation.

An Inspiring Model: Massachusetts’ Primary Care for YOU (PC4YOU)

In Massachusetts, the “Primary Care for YOU” bill (PC4YOU), introduced by Senator Cindy Friedman, proposes a legislative framework that could rejuvenate primary care and serve as a model for the nation.

Key components of the PC4YOU bill encompass:

1. Value-Based Payment Rather Than Fee-for-Service
Instead of compensating providers per patient visit, PC4YOU advocates for compensating PCPs based on patient volume, promoting lasting relationships and enabling care that focuses on prevention and continuity. Value-based models have also been shown to alleviate physician burnout.

2. Required Spending on Primary Care
The bill mandates that insurers allocate 15% of their total health care expenditure to primary care by 2029. Rhode Island enacted a similar policy, resulting in investments in health technology, PCMHs, and loan forgiveness programs—all of which fortified their primary care workforce.

3. Incentives for Innovation
PC4YOU envisions primary care that encompasses:
–