Primary Care is Broken. What Can You Do About It?
Finding & advocating for quality care is a crucial health skill
ICYMI 👉
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A woman called my office last Monday, desperate for help. She told my assistant that her primary care doctor had retired six months ago, and the earliest appointment with a new provider was ten weeks away. She'd been having chest pain for five days and had already visited the local urgent care, where she was told her EKG was normal and was advised to follow up with her doctor. But there was no one to follow up with.
"Can you help me?" she pleaded.
This scenario plays out thousands of times a day across America. We're seeing a growing population of medically orphaned Americans who lack consistent access to basic medical care. More than 100 million Americans—nearly one in three—live in areas with inadequate primary care access. Even in well-resourced suburban areas, primary care practices are closing, doctors are leaving medicine early, and wait times stretch for months. The math is stark: we need approximately 48,000 additional primary care physicians to meet current demand, and that shortage is projected to grow to 68,000 by 2036.
The primary care crisis didn't happen overnight. It's the result of decades of misaligned incentives and systemic failures. Medical school graduates increasingly choose specialties over primary care. Why wouldn't they? The job opportunities in primary care are bleak—low pay and high burnout rates. Electronic health records that promised efficiency instead have become digital albatrosses, forcing primary care physicians to spend an average of two hours on portal messages and clinical documentation for every hour spent providing direct patient care.
Doctors in the system now see up to 20-25 patients daily in 15-minute slots while managing impossible administrative burdens that leave almost no time for understanding patients' stories or addressing root causes. The result: many physicians are leaving medicine, not because they've lost their passion for healing, but because the system has made it nearly impossible to practice the kind of medicine they trained to provide.
Have you noticed the wait times to see specialists these days? That’s largely because of the shortage of primary care providers. Cardiologists are being asked to manage heart palpitations that could be handled by a primary care doctor who understands menopause. Orthopedists are being asked to manage osteoporosis that could be handled by a primary care doctor who understands skeletal health and calcium metabolism.
Emergency departments have become de-facto primary care, too. When I worked in the Johns Hopkins ED, we weren’t just treating heart failure and strokes; we were managing diabetes for patients who couldn't get insulin prescriptions renewed, treating urinary tract infections that could have been prevented with routine care, and providing mental health crisis intervention for people who'd been waiting months for psychiatric care.
Healthcare vs. Medical Care
Perhaps the worst consequence of the primary care shortage is that the public now conflates episodic medical encounters with comprehensive healthcare. There's a crucial difference between the two. I’m talking about the difference between “damage control” medical care versus whole-person healthcare. Of course treating medical problems as they arise is critical. Diagnosing infections, managing acute disease, and working up new medical problems is an intrinsic part of doctoring. And for young, generally healthy people, treating minor problems as they arise may suffice.
But when medical issues become even minimally complex, the transactional and impersonal nature of medical care in this country fails most people. This is when patients need actual healthcare—that is, a primary care medical “home.” A place for prevention and treatment of medical problems. A place to empower you to make informed decisions that align with your values and goals.
Without a medical home, chronic conditions go unmanaged until they become acute crises. Preventive care gets delayed or skipped entirely. Mental health concerns escalate without early intervention. Perhaps most importantly, patients lose the opportunity to develop a therapeutic relationship with someone who understands their whole health ecosystem—how their work stress affects their blood pressure, how their sleep patterns influence their mood, how their family history informs their risk for disease.
When you only have access to urgent care clinics and specialist appointments, you're getting medical care. But you're missing true healthcare and the opportunity to help you understand how all the pieces of your health puzzle fit together.
It's exhausting, inefficient, and often dangerous.
Where to Look for Care
The good news is that even if you're struggling to find primary care, you're not completely powerless. Here are strategies that can help:
Community Health Centers provide comprehensive primary care regardless of your ability to pay. These federally qualified health centers exist in all 50 states and often have shorter wait times than traditional practices. You can find locations at findahealthcenter.hrsa.gov.
Direct Primary Care (DPC) practices operate on a membership model to limit the number of patients under one doctor's care and to improve access to (and time with) your physician. While this requires out-of-pocket payment, DPC practices often provide 30-60 minute appointments, easier access to your doctor, and the kind of relationship-centered care that makes managing health much easier.
Nurse Practitioners and Physician Assistants can provide excellent primary care, often with better availability than physicians. Many specialize in primary care and can manage the same conditions, prescribe medications, and coordinate care just as effectively as doctors.
Telehealth platforms like PlushCare or One Medical offer virtual primary care relationships that provide continuity and care coordination, even if you can't meet in person.
Questions to Ask When Evaluating Primary Care Options
Once you've identified potential providers, it's important to evaluate whether they're the right fit for your needs. Don't be shy about asking questions—this is your health we're talking about. Here's what to ask:
About Access:
"What's your typical wait time for routine appointments?"
"How do I communicate with you between visits—by portal, phone, email?"
"Do you have same-day sick appointments?"
"Who covers when you're unavailable?"
About Care Philosophy:
"How long are typical appointments?"
"Do you coordinate care with my specialists?"
"How do you approach preventive care and health maintenance?"
"What's your experience with patients who have [your specific conditions]?"
About Logistics:
"Do you accept my insurance?" (For DPC: "What services are included in membership?")
"What happens if I need urgent care after hours?"
"How do you handle prescription refills?"
"Do you do telehealth visits?"
Making the Most of Your First Appointment
The truth is that navigating our fragmented healthcare system requires you to become a highly informed advocate for your health. This isn't fair—healthcare should be accessible to everyone regardless of their ability to navigate complex systems. But understanding the landscape empowers you to be aware of common obstacles to getting the care you need.
When you do get an appointment, preparation becomes crucial. Update your medical records and create a portable health summary to bring to the appointment. I suggest arriving with a prioritized list of concerns, focusing on your top three issues. Think ahead about what questions you most need answered, making sure you list them from most time-sensitive to least. Bring a current medication list, including supplements.
Don't be afraid to ask for what you need. If your doctor seems rushed, acknowledge the time constraint while advocating for essential information. Sometimes saying "I know we're short on time, but I really need to understand..." can help refocus the conversation on your priorities. Make a follow-up appointment right away for things you didn't get to discuss at the visit. Keep your own records of outstanding questions and issues you need help with. Don't settle. If a provider doesn't feel right after 2 or 3 visits, it's okay to try someone else.
When you find quality primary care, you'll know it. Your provider will see you as a whole person, not just a collection of body parts. They'll help you understand how different aspects of your health connect. They'll understand your experiences and dispense advice that meets you where you are. Good primary care feels like partnership, not paternalism.
The Big Picture
Individual solutions matter, but ultimately we need systemic change. Right now in the U.S., primary care receives less than 5% of total healthcare spending, and this percentage is on the decline. For comparison, other high-income countries invest an average of nearly 8% of their total healthcare spending on primary care.
It’s time for the federal government to invest in primary care and to give every American unfettered access to a primary care medical home. It’s time for the private sector to innovate, leveraging technology to elevate—not eliminate—the patient-doctor relationship.
What can you do as a mere mortal? Understand the difference between medical care and healthcare. Expect better from your insurance company and your government. Support policy changes that increase primary care funding, reduce administrative complexity, and allow primary care physicians to do the work they were trained to do. Vote for representatives who prioritize healthcare access for all. Support organizations working to expand community health centers and alternative care models. Cheer on tech entrepreneurs in the primary care space who believe in whole-person healthcare for all.
So, what happened to the desperate woman who called my office last week? She ended up seeing one of my partners (Dr. Hart!) on Friday. Her chest pain turned out to be musculoskeletal, easily managed with some physical therapy exercises, anti-inflammatory medications, and stress reduction techniques. This is what primary care should provide for everyone—not just to those who can afford it. But until our system catches up to that vision, knowing how to find and advocate for quality care is a crucial health skill.
(This is what my forthcoming book is about!)
🙋♀️ So tell me—what are your experiences with or without good primary care? Have you experienced the difference between medical care and true healthcare? I’d love to hear your stories! Also, be sure to join me today at 5 pm ET with questions!
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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Fortunate to have exc. primary care physician, but even so - the wait to reach her either directly by phone or indirectly by portal can be a few days or longer. I have confidence in her, but the demands on her time are considerable. Having been a health care provider in an allied field, I know how to navigate 'the system' but even I experience frustration and sadness that medical treatment in the U.S. has become so fractured.
After my ob-gyn retired a few years ago, I tried to find a new doctor who would take the time that he spent with me during appointments, but was unsuccessful. I decided to join a concierge family practice and was much happier; however, as I approached menopause, my family physician did not think that it was necessary to look at my hormones, which was frustrating. My total cholesterol was increasing, and she wanted me to consider a statin, which sent me over the edge. I am an exercise physiologist and have worked in cardiac rehabilitation for almost 20 years; therefore, I have a deeper understanding than the average person. Ultimately, I decided to make an appointment with a functional medicine NP, and she dug really deep into my bloodwork. I wanted to understand how my lack of hormones was affecting me and my risk for dementia and heart disease due to my family history. I have now started hormone therapy in addition to changing around my few supplements: omega, vitamin D, and recommending that I stop taking a few others that I was taking. I am feeling much better and looking forward to seeing if this additional approach will help my bloodwork before I consider more drastic treatment. If there is one thing I've learned, it is definitely important to look at a person from all sides. Looking forward to listening to the conversation today.