2025 Primary Care Scorecard Weighs
‘Cost of Neglect’

This third annual publication — titled “The Cost of Neglect” — examines the factors reducing primary care spend and charts the consequences, chief among them reduced patient access and a diminishing workforce.

The report quantifies what disinvestment looks like in stark terms:

• Primary care accounts for less than 5% of total U.S. health spending.
• Medicare and Medicaid decreased the most, dropping to 3.2% and 4.3%, respectively.
• Average reimbursement for a primary care visit is one-fifth that of a gastroenterology visit.
• The percentage of primary care nurse practitioners and physician assistants is at a new low.

Anchored by the AAFP’s Robert Graham Center research and co-funded by the Milbank Memorial Fund and The Physicians Foundation, the 2024 scorecard follows 2023’s first-of-its-kind publication by the same coalition. 

Scorecard lead author Yalda Jabbarpour, M.D., the RGC’s director and a family physician, recently told Healio: “Basically, the focus of this year’s report is all about the money — how it impacts the workforce, the training pipeline, technologies in primary care and recent research in primary care — ultimately leading to a system that is just not meeting the health care needs of the patients in the U.S.”

Jabbarpour also discusses the report on an episode of the Inside Family Medicine podcast this week.

“What we’re trying to say is that there needs to be better accountability from the health systems back to Medicare so that they can show whether they are creating a workforce that meets patient needs. And to us, we know that means primary care,” Jabbarpour says on the podcast.

Overall, the scorecard confirms that U.S. health care spending dwarfs that of all other nations: 17.8% of gross domestic product in 2020. But that doesn’t translate to population health. Americans lived to an average age of just 77 in 2020, some three years less than Germans the same year, when that country spent 12.8 of its GDP on health care (second to the U.S.).

Meanwhile, the report finds that more than 30% of U.S. adults lacked a usual source of care in 2022, the highest level in a decade of measurement. The percentage of children without a usual source of care dropped from 13.6% in 2021 to 12.4% in 2022.

The percentage of NPs and PAs in primary care dipped to 30% and 24.3% in 2022, respectively, compared with 34% and 29.7% in 2021, respectively.

The report points to “misdirected graduate medical education funding” as a key contributor to this downward trend and warns against the long-term effects of such policy.

“There was a marginal increase in the percentage of primary care residents training in community-based settings,” the scorecard says. “Still, only 15.9% of primary care residents spent most of their training in a community-based settings in 2022,” with just 5.1% of primary care residents enrolled in the Teaching Health Center Program (permanent authorization of which the Academy has long advocated to secure) or a Rural Training Track, programs focused on medically underserved communities.