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This Week in Primary Care
The More Primary Care Clinicians! Issue
The U.S. has a primary care clinician shortage. Compared with other high-income countries, the U.S. has one of the lowest numbers of doctors per capita, of whom a relatively lower proportion practice primary care.
If we want primary care for all Americans, we’re going to need more primary care clinicians– doctors, nurse practitioners (NPs), and physician assistants/associates (PAs) working together and caring for communities where they are. How do we get there?
It helps to know the shortage was created. In 1980, a report commissioned by what is now Health and Human Services argued that increasing numbers of doctors would induce more demand for medical care and therefore drive up health system costs. The report recommended immediate action to curtail training of new physicians. With collaboration from the American Medical Association and the Association of American Medical Colleges, a moratorium was established on opening new allopathic (MD) medical schools or expanding existing ones. From 1980-2005, the number of graduating doctors actually declined as the U.S. population rose by 30%. Meanwhile, the federal government established a freeze on funding for residency training slots and scaled back scholarships through the National Health Service Corps– changes that persist today. Though in 2005 the language finally switched from “surplus” to “shortage,” we are still clawing our way back.
So, how do we get more primary care clinicians, community by community and state by state?
First, let’s organize schools to train more clinicians. For the entering medical school class of 2024, ~50,000-70,000 people applied for only 31,735 spots. (MD programs: 49,648 applicants, 22,374 matriculees; DO programs: 22,107 applicants, 9,361 matriculees, no public data on how many people dual-applied.) We could open many more medical schools, and do so with an eye toward future primary care doctors. Hackensack Meridian School of Medicine, for example, gives tuition relief to a group of students who commit to a primary care discipline up front, and fully forgives the rest if they go on to train in its primary care residencies with a service commitment afterward (see feature below).
Second, let’s relieve the bottleneck of residency slots, in which newly minted doctors train under supervision for three or more years to reach independent practice in their discipline. In 2025, there were 40,051 first-year residency slots available, of which 20,300 were in primary-care disciplines (family medicine, pediatrics, internal medicine, and combined internal medicine-pediatrics.) Communities and states can open new residencies in primary-care disciplines. The majority of residents who train in a given state stay in that state. Increasing numbers of NPs are also voluntarily undertaking an additional year of postgraduate training, and we should make these slots readily available in primary care clinics.
Third, let’s encourage more clinicians to train and stay in primary care. Of the 20,300 training slots currently available in primary care disciplines, only about 5,800 of those doctors are expected to go into primary care when they graduate based on current trends. (That’s 4928 or 92% of family physicians, 1884 or 59% of pediatricians, 1362 or 12% of internists, and 226 or 57% of combined medicine-pediatrics physicians– the rest either specialize or practice hospital-based medicine.) We can improve these trends by expanding the National Health Service Corps (see our prior Teach-In with Don Weaver) and helping communities to establish scholarships like it. These scholarships could help students pay for school or repay loans, with a requirement for primary care service post-training. We can also advocate for enabling legislation like Massachusetts’ Primary Care for You, which aims to fix the work and pay of primary care such that more people will choose to practice it.
Though it is no substitute for increasing our capacity to train and retain primary care clinicians, we can increase the primary care workforce in the short term by welcoming more internationally trained physicians. Massachusetts, for example, has recently passed a law creating a pathway to full licensure for internationally trained physicians via a term of supervised clinical service in a high-need area.
In tonight’s Teach-In/Learn-In, we’ll learn from Scott Rivkees what Florida’s been doing to train and retain primary care clinicians and how that helps build up primary care. Please join us tonight at 8:30pm!
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TONIGHT: September 16th Teach-In/Learn-In!
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