There’s a remarkably simple solution to California’s primary care physician shortage | Opinion

Recently, a couple with several chronic medical conditions asked one of us for advice. “We loved our primary care physician of 20-plus years, but she retired. She was thorough, compassionate and skilled. We found a new doctor at a different practice, but he seems rushed, harried and just not-that-interested.”

In our work as physician-researchers at UC Davis Health, these kinds of concerns used to be rare. Now, they’re common. A major reason why? Primary care physicians are in short supply, with many practices refusing to accept new patients.

The federal government projects a shortfall of at least 40,000 family physicians, office-based general internists and pediatricians by 2036. Primary care patients are waiting longer for appointments (up to 29 days, according to one report), while some kids on Medi-Cal wait months for immunizations. In an attempt to widen access, primary care visits average a mere 18 minutes — not nearly enough time to address multiple chronic conditions, deliver needed preventive care, perform the requisite electronic charting and respond to patients’ electronic messages.

Meanwhile, medical students are avoiding careers in primary care in favor of specialties with higher pay and less harried schedules. Only 17% of U.S. medical school graduates report that they intended to pursue primary care (this contrasts with nearly 50% in many other developed countries).

Primary care that is worthy of the name — health care that is accessible, comprehensive, continuous and coordinated — is “critical for improving population health and reducing health disparities.” Providing such care is not only important, it can be intensely gratifying. As practicing physicians, we have both found cancer in its early, most treatable stages; watched patients’ health improve dramatically as they put our lifestyle recommendations into practice; and diagnosed serious, treatable conditions like blood clots, sleep apnea and multiple sclerosis that were missed by other specialists.

Primary care needs revitalization.

We need to radically change the way health care is valued and paid for. The current, dominant fee-for-service system is based on an outdated government-issued fee schedule developed decades ago. Influenced by powerful sub-specialty lobbies, it grossly undervalues cognitive services such as evaluating a patient’s new and as-yet undiagnosed symptoms, managing multiple illnesses simultaneously and addressing psychosocial needs. Today’s doctors lack the resources needed to invest in technological infrastructure and in team members needed to deliver outstanding primary care. As a result, clinicians are forced to practice “hamster medicine” — running as fast as possible but never managing to catch up.

Fortunately, there is a remarkably simple solution: Increase the primary care spend rate. (This is the percentage of health care expenditures from all sources — private and public — devoted to primary care.)

Total health care expenditures in the U.S. approached $5 trillion in 2023. Estimates of the primary care spend rate in the U.S. hover around 5% — compared to 15% or more in most other developed countries, all of which enjoy far better health outcomes. Gradually diverting resources from other parts of the health system toward a more robust primary care sector would likely improve access, quality and outcomes while also slowing the growth of total health care costs.

Several states (most notably Rhode Island) have begun experimenting with primary care spend rate increases, and early results are promising. In California, the Office of Heath Care Affordability is considering boosting primary care investment by 0.5% to 1% per year, aiming for a target benchmark of 15% by 2034. When combined with other recommendations (such as hybrid payment, in which practices are paid in part by fee-for-service and in part for meeting quality metrics), this new rule could dramatically improve the healthcare landscape.

Important questions remain, including: How will health care systems be held accountable for directing these new dollars to primary care? How can special interest groups such as medical specialty societies and Big Pharma be prevented from derailing these efforts? How should new resources be optimally directed to assure high quality, equitable primary care for all?

To address these and other issues, UC Davis is hosting a Summit on Revitalizing Primary Care, from Oct. 16-18. The event, open to the public and featuring an array of experts from around the country, is a unique opportunity to convene some of the greatest minds in health care policy to discuss the most viable solutions to a growing problem.

Although the Summit will not be of immediate help to the couple seeking a primary care physician who can spend more time with them, we know that if these and similar efforts are successful, accessing high quality primary care will not be such a challenge in the future.