Medicare Primary Care Shortage: What Seniors Need to Know

Without urgent policy intervention, the ongoing slide in primary care provider (PCP) availability could inflict long-term damage on health care for many Americans and lead to long-term instability of the US health care system, especially for those enrolled in Medicare fee-for-service (FFS) plans seeking new patient visits. Further, this decline has so far not been demonstrably ameliorated by the rise in total advanced practice clinicians (APCs; ie, nurse practitioners and physician assistants), according to a cross-sectional study published online today in JAMA Internal Medicine.^1,2

“While the declining number of practicing PCPs is well described, a recent trend in PCPs reducing panel sizes calls for new methods to measure the supply of primary care services,” the authors wrote,¹ highlighting a nearly 9-percentage-point increase in US adults without a new PCP between 2013 and 2022: from 21% to 30%.

Data were analyzed from claims submitted by PCPs between January 2013 and December 2021 for Medicare FFS administrative claims and Part B and Part D public use files. For this investigation, active PCPs were family practice, general practice, geriatrics, internal medicine, or preventive medicine physicians, and primary care APCs with records of at least 50 outpatient visit evaluation and management codes.

The numbers show a potentially dismal overall forecast. PCPs available for new visits decreased from 75,140 in 2013 to 56,483 in 2021, or by 24.9%. In sharp contrast, APCs available for new visits jumped exponentially in those same years by 91.4%, starting at 12,768 and ending at 24,432.

Drilling down to per 10,000 FFS Medicare beneficiaries, by 2021, total clinicians available for new visits, total new visits, and total PCPs all fell, while available APCs again rose:

• Total clinicians: 23.4 to 22.2 (–5.1%)
• Total new visits: 1162 to 1102 (–5.2%)
• Total PCPs: 20.0 to 15.5 (–22.5%)
• APCs: 3.4 to 6.7 (97.1%)

For completed new visits, decreases were seen across the board again in relation to PCPs for both total new visits, from 86.1% to 69.9%, and availability, from 57.0% to 47.5%.

Even though these declines in PCP availability are accompanied by an increase in APC availability, the authors conclude that barriers to care will still be thrown up because of longer wait times overall for new patient visits and limited access to new practitioners. They also highlight that their findings echo previous research on provider burnout,³ which is leading many PCPs to leave the field or reduce their clinical hours.²

In an accompanying editorial, authors echo how these decreases are happening in conjunction with an aging US population and emphasize that specifically using Medicare FFS data enables a more nuanced view into primary care.² In particular, even though APCs are increasing in numbers, that doesn’t necessarily mean they are the solution to this provider crisis, “because APCs are subject to the same financial and work condition incentives as physicians and are increasingly choosing to work in subspecialty settings.”

Underneath these trends lies an increasingly complex environment in which medical advances take up more of the already inadequate time clinicians have to spend with their patients, administrative burdens keep growing, methods of communication are disjointed, and payment models are outdated. The editorial authors offer several potential solutions. Among them are reforming medical school education by way of incorporating more primary care experiences, reducing length overall, and offering free tuition or tuition relief contingent on students committing to a career in primary care.⁴ They also propose lifting immigration restrictions for non–US-born trainees who are more likely to enter primary care and serve patient populations in underserved areas, as well as payment reform via greater parity with subspecialty procedural disciplines to make the job more sustainable.

The authors of the study and the editorial note that a primary limitation on these findings is the concentration of Medicare FFS patients, who are likely to experience higher levels of illness and different barriers to care compared with a wider patient population.

References

1. Morgan KM, Karadakic R, Barnett ML. Primary care clinicians available for new patient visits. JAMA Intern Med. Published online January 20, 2026. doi:10.1001/jamainternmed.2025.7465
2. Brender TD, Rittenberg E, Durant RW, Ganguli I. A different lens on the primary care workforce shortage—who is accepting new patients? JAMA Intern Med. Published online January 20, 2026. doi:10.1001/jamainternmed.2025.7462
3. Neprash HT, Chernew ME. Trends in physician exit from fee-for-service Medicare. JAMA Health Forum. 2025;6(7):e252267. doi:10.1001/jamahealthforum.2025.2267
4. Emanuel EJ, Guido M. Free med school tuition won’t solve the shortage of primary care physicians. Stat News. April 22, 2024. Accessed January 20, 2026. https://www.statnews.com/2024/04/22/free-medical-school-tuition-primary-care-doctor-shortage