The primary care landscape in the United States is facing a defining challenge. Despite the expansion of healthcare coverage and growing population needs, the supply of primary care physicians (PCPs) has not kept pace. A new study titled “US Primary Care Workforce Growth: A Decade of Limited Progress, and Projected Needs Through 2040” by Bazemore, Petterson, and McCulloch, published in the Journal of General Internal Medicine in 2024, paints a sobering picture of the road ahead. The findings reveal that unless strategic action is taken, the primary care system may soon reach a breaking point.
The Backdrop: More Coverage, Fewer Doctors
Since the passage of the Affordable Care Act (ACA) in 2010, over 31 million Americans have gained health insurance. This was expected to increase demand for primary care services significantly. Yet, a key challenge remains: the number of available primary care physicians has not grown at the rate needed to support this shift. Particularly in rural and underserved communities, the gap between patient needs and physician availability continues to widen.
The COVID-19 pandemic amplified these pressures. Not only did it increase the demand for healthcare services, but it also accelerated burnout among healthcare providers, especially those in primary care settings. The result has been a steady exodus of clinicians from the field, coupled with a rising number of new graduates opting for hospitalist or specialty roles rather than primary care.
Workforce Trends: Growth That Isn’t Enough
Between 2012 and 2020, the U.S. primary care workforce grew from 255,170 to 275,809 — a net gain of just 20,639 clinicians. However, when adjusting for the rising number of primary care-trained physicians who transitioned into hospitalist roles (up from 29,825 to 39,312 during that period), the real net gain of active PCPs was just over 11,000. This modest increase falls drastically short of the projected need.
Meanwhile, nurse practitioners (NPs) and physician assistants (PAs) have seen rapid growth. From 2016 to 2020, nearly 20,000 NPs and around 6,000 PAs were added to the workforce annually. While this growth is promising, it cannot fully compensate for the deficit of physicians, especially in roles requiring more extensive training or specialization.
Utilization Patterns: Are Patients Seeing PCPs Less?
Interestingly, while the number of PCP visits has remained stable, the average number of visits per capita has declined. From 2010 to 2019, per capita PCP visits dropped from 1.67 to 1.56. The study attributes this decline to a shift toward NPs and PAs, whose visits have increased over the same period. Although these providers are crucial in maintaining access, the complexity of care and oversight responsibilities often still rely on physicians, especially in chronic disease management.
Projected Needs: Looking Ahead to 2040
According to population and demographic forecasts, the number of office visits to primary care providers is expected to grow from approximately 773 million in 2020 to over 893 million in 2040. To accommodate this demand, an additional 57,559 primary care clinicians will be needed.
This projection is based on factors including:
- Population growth
- Aging demographics
- Increased prevalence of chronic conditions
- Expanded healthcare access
However, without significant policy or structural changes, this gap may continue to grow.
The Rural Divide: Maldistribution of Care
Another major issue highlighted in the study is the geographic maldistribution of primary care physicians. Rural areas represent nearly 20% of the U.S. population but account for less than 8% of practicing physicians. On average, rural communities have about 55.1 PCPs per 100,000 people compared to 79.3 in urban/suburban areas.
This disparity has major consequences:
- Higher mortality rates in rural regions
- Increased incidence of unmanaged chronic diseases
- Reduced preventive care access
Many rural hospitals and clinics face closure or reduced hours due to staffing shortages, further straining healthcare delivery in these regions.
Contributing Factors to the Crisis
Several factors contribute to the shortfall of primary care clinicians:
- Burnout and Workload: The demanding nature of primary care, combined with administrative burdens and emotional exhaustion, has led many to leave the profession.
- Financial Disincentives: PCPs often earn less than specialists, leading new graduates to pursue more lucrative roles.
- Training Pipeline Issues: A growing number of internal medicine and family medicine residents are shifting to non-primary care roles, including hospital medicine and subspecialties.
- Urban Bias: Training programs are often located in urban centers, discouraging placement in rural communities.
- Policy Gaps: Despite the ACA’s expansion of coverage, there has been insufficient investment in the primary care workforce pipeline.
NPs and PAs: The Unsung Heroes?
The growth of nurse practitioners and physician assistants has helped mitigate some of the damage. These providers are more likely to work in underserved areas, accept Medicaid patients, and provide preventive care.
However, they face their own limitations:
- Scope of practice laws vary widely by state
- Limited support or mentorship in rural settings
- Often not a full substitute for physician-level care in complex cases
Still, their contribution is significant and growing. Ensuring proper training, autonomy, and integration into the care team is essential.
What Needs to Be Done?
The study calls for systemic change to address these challenges. Key recommendations include:
- Expand and Fund Residency Slots: Increase the number of primary care residency programs, especially in rural and underserved areas.
- Support Clinician Well-being: Address burnout through mental health resources, better work-life balance, and reduction in administrative burden.
- Enhance Payment Models: Shift toward value-based care that rewards preventive services and chronic disease management.
- Leverage NPs and PAs: Standardize scope-of-practice regulations and ensure support for team-based models of care.
- Encourage Rural Practice: Provide loan forgiveness, housing stipends, and career development opportunities to clinicians who serve in rural settings.
- Data Transparency: Track workforce trends more effectively to enable better planning and policy development.
Conclusion: A Crossroads for Primary Care
The U.S. is at a critical juncture. The demand for primary care is growing, yet supply is not keeping pace. Without meaningful change, more Americans will face delays in diagnosis, increased hospitalizations, and preventable health complications.
As the study underscores, the path forward requires coordinated efforts across federal policy, state regulation, healthcare education, and delivery systems. It also calls on medical professionals, policymakers, and the public to value and invest in primary care as the cornerstone of an effective and equitable healthcare system.
The clock is ticking. With over 57,000 additional clinicians needed by 2040, the time to act is now.
Citation: Bazemore A, Petterson S, McCulloch E. “US Primary Care Workforce Growth: A Decade of Limited Progress, and Projected Needs Through 2040.” Journal of General Internal Medicine. 2024. https://doi.org/10.1007/s11606-024-09121-x