If you've recently had difficulty getting an appointment with a primary care physician (PCP), you're not alone. According to Kaiser Health News, 60 million Americans—nearly 1 in 5—lack adequate access to primary care due to a shortage of physicians. Unfortunately, healthcare experts expect this problem to grow: currently, the U.S. needs about 9,000 more PCPs, and the shortfall may reach 65,000 over the next 15 years.

The PCP Problem

This crisis has been in the making for some time. As our population ages, more people will develop chronic diseases and need care. The Affordable Care Act (ACA) will provide insurance to millions of additional citizens, who will also seek primary care services, further straining the supply of PCPs. In fact, according to the AARP (American Association of Retired Persons), the demand for PCPs is so high that many physicians do not accept Medicare, the popular health insurance program for older adults. (Medicare is administered by the government and provides lower reimbursements to physicians than private insurance.)

An additional complication is due to the fact that our healthcare system compensates physicians for procedures. Specialists perform more procedures than PCPs and thus earn more, making primary care a less attractive option for the next generation of doctors.

The situation is serious: Compared to other high-income democracies, Americans die younger and have poorer overall health, in part because many people have limited access to primary care. Furthermore, higher numbers of specialists in a population correlates with higher mortality rates. (One explanation for this may be that patients with a reliable source of primary care tend to use more preventive services and seek care earlier, when health problems are generally easier to treat.)


There is good news, however. We have proven ways to reduce the burden on, and shortage of, PCPs:

  • One of the most favored solutions is a team-based approach. With this model, different types of providers, including physicians, physician assistants (PAs), nurse practitioners, nurses, and care coordinators provide primary care services. Patients with routine problems might see a nurse practitioner or PA, for example, freeing physicians to care for patients with more serious problems. Research suggests that nurse practitioners can perform a subset of primary care services as well as, or better than, physicians. (The ACA includes provisions to increase primary care workforce training.)
  • Experts have proposed other solutions as well, including reducing student loan debt for PCPs, reforming payment policies, and allowing more foreign physicians to practice in the U.S.

Although the American College of Physicians and others have outlined proposed policies to address this problem, the U.S. has not yet implemented any of these strategies. Unfortunately, without adequate primary care, our healthcare system will become increasingly fragmented and inefficient, continuing the trend of poorer quality care at higher prices.

Liesa Harte, MD, reviewed this article.


Pauline W, MD. "Where Have All the Primary Care Doctors Gone?" NYTimes.com. Blog. Web. 20 December 2012. Page accessed 13 August 2013. http://well.blogs.nytimes.com/2012/12/20/where-have-all-the-primary-care-doctors-gone/

National Governors Association. "The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care." Web. 20 Dec. 2012. Page accessed 13 August 2013. http://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html

Mercer, Marsha. "How to Beat the Doctor Shortage." AARP Bulletin. Web. March 2013. Page accessed 13 August 2013.  http://www.aarp.org/health/medicare-insurance/info-03-2013/how-to-beat-doctor-shortage.html

Zerehi, M. Renee. "How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?" Philadelphia: American College of Physicians; 2008: White Paper. Web. Page accessed 13 August 2013. http://www.acponline.org/advocacy/current_policy_papers/assets/primary_shortage.pdf

Cullen, Esme, Ranji, Usha, and Salganicoff, Alina. "Primary Care Shortage." Kaiser Family Foundation. Web. April 2011. Page accessed 13 August 2013. http://www.kaiseredu.org/Issue-Modules/Primary-Care-Shortage/Background-Brief.aspx