Across the healthcare industry, experts agree (and research shows) that access to primary care plays a key role in keeping people healthy. But over the past decade, spending on primary care has declined, as has the number of primary care providers in the U.S. A new report from the Milbank Memorial Fund shows that these trends are not slowing down.

The report points to a variety of factors leading to declining primary care access, which has continued at least through 2022:  

• Funding: Spending on primary care in the U.S. dropped from 4.7% of total Medicaid costs in 2021 to 4.3% in 2022; Medicare primary care spending went from 3.9% to 3.4% in the same year. The decreases are more pronounced over a longer time period: Primary care spending dropped from 6.2% of overall healthcare spending in 2013, across all payers, to 4.6% in 2022. The American Medical Association has calculated that Medicare physician payments have dropped 29% since 2001 when adjusted for inflation.  

• Current Workforce: The number of primary care providers—which includes doctors, physician associates, and nurse practitioners—dropped from 105.7 per 100,000 people in 2021 to 103.8 per 100,000 in 2022.  

• Future Workforce: Many medical students are opting for higher-paying specialties over primary care. While the number of primary care residents remained at 17 per capita between 2020 and 2022, the rate of all specialties increased from 29 to 30 per capita. The American Academy of Pediatrics reported that 92% of pediatric residencies were filled in 2024, compared to 97.1% in 2023.  

• Time-Consuming Documentation Processes: More than 25% of family physicians said they were “very dissatisfied” or “somewhat dissatisfied” with their Electronic Health Record (EHR) systems, which can eat up valuable time and prevent them from seeing additional patients.  

These factors are making primary care less attractive for many current and future care providers, and the Association of American Medical Colleges (AAMC) points out that as the U.S. population grows and ages, a projected third of active physicians will retire in the next decade. The AAMC predicts that there will be a shortage of 20,200 to 40,400 primary care physicians by 2036.

Rural Communities and Primary Care

Areas historically underserved by the healthcare industry, including rural areas, are particularly vulnerable to shortages. The American Medical Association reports that about 65% of rural areas have a shortage of primary care providers and 136 rural hospitals closed between 2010 and 2021.  

These trends have real consequences: “Rural residents have higher rates of cigarette smoking, high blood pressure, and obesity. They also have higher rates of poverty, less access to healthcare, and are less likely to have health insurance,” according to the Centers for Disease Control. Early death from the five leading causes of death—heart disease, cancer, injury, chronic lower respiratory disease, and stroke—is more common in rural than urban areas.  

‍Transportation in Focus

What are the benefits of primary care? PCPs can help detect and treat medical conditions and diseases earlier, they can help patients manage chronic diseases effectively, and they provide preventative services such as vaccinations and medical screenings.  

There can be multiple barriers to receiving primary care, including insurance coverage, language, childcare, work obligations, and transportation: The American Hospital Association reports that every year, 3.6 million people in the U.S. don’t get medical care because of transportation challenges. When there are fewer primary care providers, often spread further apart, transportation becomes even more crucial to ensure people can get to their appointments—and ideally develop a relationship with their care provider.

The good news is that Medicaid and many Medicare Advantage health plans do offer transportation benefits for members who don’t have reliable transportation. Non-emergency medical transportation is a crucial lifeline for millions of people across the country, in both rural and urban areas.  

SafeRide Health has been working with the nation’s health plans for nearly 10 years to ensure patients can access the care they need. This year, SafeRide will provide more than 9 million rides to Medicaid and Medicare Advantage health plan members—and we can also play a role in helping to identify which members are experiencing socials determinants of health (SDoH) that create barriers to care. We recognize, along with healthcare professionals and policymakers across the country, that when people can and do access primary care, they have a better chance of staying healthy.  

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