New Scorecard Report on the U.S. Primary Care System

In 2021, the National Academies for Sciences, Engineering, and Medicine (NASEM) released their report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care,” which proposed a plan to strengthen primary care. After this report’s publication, the Milbank Memorial Fund established its annual Health of US Primary Care Scorecard to track the status of primary care in the United States. “The Health of US Primary Care 2025 Scorecard—The Cost of Neglect How Chronic Underinvestment in Primary Care Is Failing US Patients” (the 2025 Scorecard Report) focuses on the downward trend in primary care financing, flaws in the fee-for-service (FFS) payment system, and threats facing the primary care workforce as a result of insufficient funding. Ultimately, an unproductive primary care system jeopardizes the health and safety of every community.

The 2025 Scorecard Report identifies the following five key challenges undermining the primary care system in the United States.

Challenge 1: Primary care clinicians cannot meet patient needs because of the FFS payment system and declining financial investment in primary care.

Primary care spending has been decreasing since 2018¹. According to the 2025 Scorecard Report, these spending decreases have occurred across all payers, most prominently among Medicare and Medicaid. In 2022, the United States spent less than 5% on primary care. The average reimbursement rate for a primary care physician (PCP) visit is much lower than other specialties; the 2022 average PCP visit reimbursement was $259, whereas for a gastroenterology visit, the average reimbursement was $1092.

Recently, states have led the effort to strengthen primary care funding. A Milbank Memorial Fund report highlights five states prioritizing primary care spending. These states (California, Connecticut, Oklahoma, Rhode Island, and Virginia) are establishing spending targets and engaging state policymakers to re-center primary care in their healthcare priorities. Calls for primary care payment reform arise partly from frustrations with the existing FFS payment system. Another recent Milbank Memorial Fund report reviewed exemplary state-level primary care policies in Arkansas, Colorado, Delaware, Rhode Island, and Washington. For states looking to strengthen their primary care policies, the authors recommend alternative payment models, increased financial investment in the primary care system, and alignment of payment approaches across payers.

Challenge 2: Inadequate funding contributes to workforce reductions and, ultimately, restricts patient access to primary healthcare.

The number of primary care clinicians per 100,000 people decreased from 105.7 in 2021 to 103.8 in 2022. Workforce reductions take a toll on existing primary care clinicians. A study conducted by The Commonwealth Fund examining burnout among PCPs found that 45% of PCPs surveyed reported burnout; of these PCPs, 39% indicated that they planned to stop seeing patients in the coming years. The burnout and exhaustion facing the primary care workforce pose an existential threat to the primary care field, as they may further exacerbate patient access barriers. The percentage of U.S. adults lacking a usual source of care hit its highest value in a decade in 2022 at 30%, despite higher-than-normal insurance coverage rates.

Challenge 3: Fewer new PCPs are joining the primary care workforce, despite increased funding efforts.

The United States is projected to have a shortage of 68,020 PCPs by 2036². The 2025 Scorecard Report notes the percentage of new physicians entering the primary care field dropped to its lowest value in a decade, at 24.4% in 2022. Paradoxically, states with increased Medicare and Medicaid graduate medical education (GME) funding had lower percentages of new PCPs. Though community-based approaches to primary care help to improve access to services³, a limited number of primary care residents spend time in community-based settings (15.9% in 2022). The traditional FFS system may implicitly disincentivize community-based training as it does not compensate for physician mentorship in community settings.

Challenge 4: Limited financial investment in electronic health records (EHRs) leads to administrative burden for clinicians and reduces patient access to care.

Approximately half of family physicians rate EHRs’ usability as poor or fair and over a quarter remain dissatisfied with their systems. Administrative burden, combined with increased workload and moral distress, contributes to PCP burnout and exhaustion. In a survey of PCPs who experienced symptoms of burnout, 97% expressed frustration about the time spent on administrative work and 94% struggled with the daily workload².

Challenge 5: There is a lack of research funding to find evidence-based improvements in care.

Research is vital to determining the effectiveness and scalability of innovations within the primary care field. The 2025 Scorecard Report notes that although total federal healthcare research investment marginally increased in 2023, the investment in primary care research is still below 1%.

The Milbank Memorial Fund’s 2025 Scorecard Report underscores the criticality of a properly funded primary care system. The current FFS payment model, workforce shortages, suboptimal EHRs, and insufficient research efforts remain obstacles to access and high-quality patient care. The 2025 Primary Care Scorecard Data Dashboard provides state-specific data on primary care indicators.

For more information on:

• Sustainable primary care funding - see the Agency for Healthcare Research and Quality’s (AHRQ) “Finding Sustainable Funding for Primary Care Extension Programs” report.
• New reimbursement models aiming to strengthen primary care - read the AHRQ Academy’s news story, “Strengthening Primary Care – New Reimbursement Models.”
• How to address burnout in primary care practices - see AHRQ’s “Burnout in Primary Care” report.
• How to improve care quality and implement evidence-based practices – see AHRQ’s EvidenceNOW Model, which provides a blueprint for supporting primary care organizational efforts. provides a blueprint for supporting primary care organizational efforts.
• Cost effectiveness potential for integrated behavioral health - see the Milbank Memorial Fund’s blog post, “Integrated Behavioral Health Works and Saves Money. Why Aren’t We Doing It?”

To learn more about existing primary care research efforts, visit the following websites:

• North American Primary Care Research Group (NAPCRG)
• AHRQ’s Primary Care Practice-Based Research Networks
• AHRQ’s National Center for Excellence in Primary Care Research

References

1. Foubister V. Five States Leading Efforts to Increase Primary Care Spending. Milbank Memorial Fund. Accessed June 24, 2025. https://www.milbank.org/publications/states-lead-efforts-to-increase-primary-care-spending/
2. Horstman C. A Poor Prognosis: More Than One-Third of Burned-Out U.S. Primary Care Physicians Plan to Stop Seeing Patients. doi:10.26099/EVWB-8T35
3. Callaghan KA. Establishing Community-Based Primary Health Care. In: Arxer SL, Murphy JW, eds. Community-Based Health Interventions in an Institutional Context. Springer International Publishing; 2019:23-38. doi:10.1007/978-3-030-24654-9_3