As a premedical student, you’re likely focused on mastering the basics of biology, chemistry, and physics while navigating the complexities of medical school applications. However, there’s an important issue in healthcare that you should be aware of as you prepare for a future in medicine: the growing shortage of primary care physicians in the United States.
Primary care physicians (PCPs) include family medicine doctors, internists, pediatricians, and sometimes obstetricians/gynecologists who provide comprehensive, first-contact care for patients. They play a critical role in maintaining public health by offering preventive care, managing chronic conditions, and coordinating patient care across various specialties.
However, the U.S. is facing a significant shortage of PCPs. According to the Association of American Medical Colleges (AAMC), the country could see a shortfall of up to 86,000 primary care physicians by 2036.
Understanding this shortage is crucial, as it not only affects healthcare delivery but also shapes the opportunities and responsibilities that may define your future career. This article looks at some of the major factors driving the shortage of primary care practitioners.
An Aging Population
America is getting greyer. In 2023, the U.S. Census Bureau reported that the median age of Americans was now 38.9 years old – up from a median age of 30 in 1980.
As the population ages, demand for healthcare services, particularly in primary care, increases. Older adults typically require more medical attention, often for multiple chronic conditions, which puts additional strain on the existing healthcare system.
In fact, a 2020 report from the U.S. Centers for Medicare and Medicaid Services (the most recent statistical year available) found that the annual per-capita cost of medical care for adults over 85 was 8.5 times higher than the per-capita cost of medical care for children. This report also found that per-capita spending for older adults was rising faster than for any other age group.
An Aging Workforce
A significant portion of the current primary care workforce is nearing retirement. A 2021 report from the AAMC found that two of every five PCPs would be over age 65 by the end of the 2020s. A 2024 article from the American Medical Association (AMA) notes that 30% of physicians across all specialties retire between the ages of 60 and 65.
As these physicians leave the workforce, there aren’t enough new doctors entering primary care to replace them. A November 2023 article on the primary care shortage from CBS notes that, according to the National Resident Matching Program, only 89% of family medicine residency slots were filled in 2023, compared with an overall residency fill rate of 93%.
Medical School Debt and Compensation
One reason why many medical students choose to pursue specialties other than primary care is the fact that it can pay less than other specialties. This is of particular concern in an era of high medical school debt. A 2023 article in Forbes notes that the median amount of debt for U.S. medical students is $250,995, and that a standard 20-year loan at 6% interest would mean paying out more than $400,000 total. That debt burden influences student decisions. As our president, Dr. David Lenihan, noted in an April 2024 U.S. News & World Report article, “A big reason [medical students avoid pursuing primary care] is often because the income potential is better in more specialized fields."
Medscape’s 2023 Physician Compensation Report (slide 3) found that the highest-paying medical specialty, plastic surgery, commanded an average annual salary of $619,000. That’s more than double the average salary for a family medicine specialist, which was $255,000.
Higher Burnout Rates
Burnout – exhaustion and disillusionment caused by chronic overworking in difficult conditions – is a major issue for the medical workforce, especially in the years following the acute phase of the COVID-19 pandemic. According to a 2024 report from the AMA, of the top six physician specialties most affected by burnout, four were in primary care fields:
- Family medicine
- Internists
- Pediatricians
- OB/GYNs
A 2022 Harvard Medical School article about the burnout crisis in primary care reports that rising administrative burdens coupled with a shortage of clinical and support staff are the major drivers behind PCP burnout. It also notes that another contributing factor is location.
Geographic Disparities
The shortage of PCPs is more pronounced in some areas than in others. We’ve written previously about the rural healthcare crisis with regard to hospital closures, but PCPs are also in short supply in rural regions, as well as underserved urban communities.
A look at the U.S. Health Resources and Services Administration’s health professional shortage areas (HPSA) dashboard shows where the most shortages are. California and Texas top the list, but Alaska, a heavily rural state with a low population, is third. Most of the other top ten states also have significant rural populations.
Why Should Premedical Students Care?
Future physicians need to understand the primary care shortage because primary care is foundational to the entire healthcare system. Whatever specialty you wind up practicing in, you will have to interact at some level with primary care services – or with the effects of health issues exacerbated by a lack of primary care access.
A 2021 report from the National Academies of Sciences, Engineering, and Medicine states that “without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels.” These effects can impact underserved communities, where healthcare disparities are already a major concern, the most.
Keep an Open Mind as You Study
If you’re considering a career in medicine, it’s important to keep an open mind about primary care. Here are some steps you can take as a premedical student to explore this path:
- Spend time shadowing primary care physicians to gain a firsthand understanding of their work and the challenges they face.
- Volunteer in community health clinics or other settings where primary care is delivered.
- Look into medical school loan repayment programs, scholarships, and incentives offered to those who choose primary care, particularly in underserved areas.
- Keep up with healthcare news and policy developments related to primary care.
Understanding the broader context of the healthcare system will help you make informed decisions about your career path. If you want to strengthen your application to an MD program, DO program, or even a physician associate (PA) program and pursue primary care, our university partners can help. Find a Tiber Health MSMS partner near you!
