Physicians Sound Alarm on Primary Care Infrastructure

Submitted on Thu, 08/26/2021 - 09:32

New England Journal of Medicine article by primary care leaders sounds an alarm about our nation’s crumbling primary care infrastructure and calls on Biden administration to urgently appoint a Secretary’s Council on Primary Care as recommended by National Academies of Sciences, Engineering, and Medicine report.

“A national infrastructure package must rebuild primary care, not just roads and bridges,” says the article’s lead author.


In an article published in the New England Journal of Medicine, Revitalizing the U.S. Primary Care Infrastructure, leaders of primary care research and policy centers from across the country decry the neglected state of primary care in the US and call on the Biden administration to implement the recommendations of a recent National Academies of Sciences, Engineering, and Medicine (NASEM) report to revitalize the nation’s primary care infrastructure. The authors emphasize the top recommendation of the NASEM Committee on Implementing High-Quality Primary Care to establish a council on primary care under the Secretary of Health and Human Services (HHS) responsible for coordinating primary care policy across HHS agencies.

“If a council focused on primary care had been in place during the height of the COVID-19 pandemic in the United States, it could have helped rapidly mobilize primary care to address vaccine equity and shore up public health, particularly in rural and historically marginalized urban communities,” write the authors.  They note that even before the pandemic, average life expectancy was already 3.4 years shorter in the United States than in other wealthy countries—countries that invest a higher share of their health care resources in primary care. They add, “Among the many factors contributing to the neglect of primary care, including current payment systems, one critical deficit could be readily addressed: the absence of a government entity that is responsible for defining and overseeing implementation of a coordinated national primary care strategy.”

The United States has paid a high price during the COVID-19 pandemic for its underinvestment in public health but is still discovering the tragedy of its related inattention to primary care. “Primary care is the essential foundation of a well-functioning health system, but the foundation is crumbling from decades of underinvestment--at great peril to the nation’s health,” says lead author Dr. Kevin Grumbach, Hellman Endowed Professor of Family and Community Medicine at the University of California San Francisco (UCSF) and Founding Director of the UCSF Center for Excellence in Primary Care. “A national infrastructure package must rebuild primary care, not just roads and bridges.”

The article notes that more than half of physician office visits in the US are to primary care physicians, but only 5.4% of national health expenditures are spent on primary care. Between 2005 and 2015, the number of primary care physicians in the United States decreased by 5.2 per 100,000 people (from 46.6. to 41.4 per 100,000 people) while the number of specialists increased, and average wait times for new patient appointments in primary care lengthened from 20 days in 2014 to 30 days in 2017.

“Right now, no agency or leader at HHS is accountable for making sure that primary care works for everyone in America,” says Dr. Robert Phillips, Director of the American Board of Family Medicine Foundation’s Center for Professionalism & Value in Health Care, and co-chair of the NASEM Committee on Implementing High-Quality Primary Care. “Primary care is the only part of the health care system that reliably improves health outcomes, and the Federal Government needs a team of people who go to work every day tasked with ensuring that everyone has access to high-quality primary care.” The NASEM committee proposal for a Secretary’s council on primary care is modeled on similar successful approaches to tackling national health priorities, such as the White House COVID Vaccine Task Force and the HHS Data Council. The authors argue that while a Secretary’s council on primary care alone won’t be sufficient to solve the problem of poorly supported primary care, it is necessary to prevent further erosion of the most important infrastructure available for achieving health equity.

The 6 authors of the report (Drs. Kevin Grumbach, Thomas Bodenheimer, Deborah Cohen, Robert Phillips, Kurt Stange, and Jack Westfall) are members of the Primary Care Centers Roundtable, comprised of directors of many of the nation’s most prominent primary care research and policy “think tanks” based at universities and family medicine professional societies. Twelve additional members of the Roundtable endorsed the article. Three Roundtable members served on the NASEM Committee on Implementing High-Quality Primary Care. The Primary Care Centers Roundtable includes the following centers:

  • Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco
  • Center for Primary Care Research and Innovation, Department of Family Medicine, Oregon Health and Science University
  • The Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation
  • Robert Graham Center, Washington, DC
  • Center for Community Health Integration, Case Western Reserve University
  • Larry A. Green Center, Virginia Commonwealth University
  • Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine
  • National Center for Family Medicine, Morehouse School of Medicine
  • Department of Family and Community Medicine, University of Texas, San Antonio

For more information or to request an interview with authors, please email [email protected] or call 859-287-0948.