Primary Care Scorecard Raises Red Flags, Cites Policy Solutions

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, spoke with AAFP News about the report.    

What is the scorecard, and what does it measure?  

In 2021, the National Academies of Sciences, Engineering and Medicine put out a report on primary care, identifying some of the problems we’ve since done more research into. The report basically called for a tracking tool, a way to measure — year by year, if possible — what would happen if we invested more in high-quality primary care.   

Milbank and The Physicians Foundation enlisted the help of the Robert Graham Center to track these measures in a report and accompanying dashboard. We’re monitoring trends of how the primary care workforce is doing. How many primary care clinicians are there? Where are they working? How are we training people to become PC clinicians? What’s the total spending in each state toward primary care? Is tech such as electronic health records helping PC clinicians or creating burden?   

The report examines these things on a national basis but also plugs the data into a detailed dashboard that allows physicians to look at what’s happening where they practice. It doesn’t compare states but instead shows the individual progress of each state over time.  

You’re a practicing family physician as well as the Graham Center director. What do you think the key takeaways are for members?  

The average family doc has seen workforce numbers lower for a decade while experiencing a higher demand from patients, and we wonder: Is this pressure happening only where I am? And the answer is no — no, you’re not going crazy. There really are fewer of us.  

One thing this means is that we all have to do our part to train the future. We know that students and residents will stay in primary care only if they actually experience true primary care. It’s on all of us to help train future family physicians, to accept students and accept residents into our practices, to help build the workforce.  

As far as the scorecard goes, family physicians who want to advocate with policymakers or health systems can say, “Look at this: The physician density is going down. Patients can’t get in to see me.”   

What can family physicians do at the practice level to start addressing these problems, which the report makes clear will take a long time to fix systemically?   

Yes, it’s going to take a long time. And in the meantime we need a better solution — and that solution really is team-based care.  

There simply are not enough doctors to go around. We need to build strong health care teams and count on the nonphysician members of those teams to help us. If you have control over hiring team members, hire people who can help really do that work.  

That fact that a lot of us family physicians do want to move toward a team-based model is, I think, a glimmer of hope.   

Speaking of hope, you’ve said the data do contain some cause for optimism. Can you expound on that?  

When you look at areas of high social disadvantage, there’s actually a higher clinician density. I think that speaks to the mission-oriented thinking of primary care. We really are there to help the communities that need it most.  

Is that enough? No. Even the highest density we found is 67.2 clinicians per 100,000 patients. So the actions we recommend in the report really need to happen.   

Again, the part we have some control over involves focusing on building up our teams and redistributing the type of work we do. That might mean doctors as quarterbacks seeing the most complex patients while, for instance, nurses help do medication management, triage patients and answer portal messages.