Primary care, reimagined: Workforce and care model innovation in a modern age

Historically, a primary care practitioner has been the first point of contact for preventive care—administering vaccines or ordering colonoscopies—as well as for diagnosing and managing illnesses and conditions from ear infections to obesity. Primary care serves as the backbone of the health system: When providers are not providing continuous care throughout a patient’s life, they are referring patients to specialists for what they suspect could be a mental disorder, a type of cancer, or an orthopedic problem. In its ideal state, primary care strengthens population health, enhances quality of life, and extends life expectancy.

However, despite broad consensus on its importance, access to primary care remains a global challenge. While there are wide variations in populations and funding, common themes include wait times, access to care, and healthcare workforce shortages. This ranges from almost 60 percent of UK adults in a survey saying they have the most difficulty accessing general practitioner (GP) services; 54 percent of participants with unmet needs in a Canadian study citing long wait times as the main reason; to around half of public primary care positions in Sierra Leone being filled by unsalaried volunteer workers and 5 percent of Haiti’s rural population having access to good quality primary care.¹The state of health care and adult social care in England 2023/24, Care Quality Commission, October 25, 2024; Feben W. Alemu et al., “Unmet need and access to family physicians: A national analysis using the Canadian Longitudinal Study on Aging,” SSM - Health Systems, December 2024, Volume 3, Number 100028; Pieternella Pieterse and Federico Saracini, “Improving Sierra Leone’s skilled health-worker-to-population ratio: how unsalaried and auxiliary health workers are barriers in its path to universal health coverage,” BMJ Global Health, November 2025, Volume 10, Number 11; Anna D. Gage et al., “Assessing the quality of primary care in Haiti,” Bulletin of the World Health Organization, February 2017, Volume 95, Number 3.

Yet what distinguishes the United States is not only uneven access to primary care but also underinvestment in the very system intended to keep people healthy. While other OECD countries allocate roughly 13 percent of their health spending to primary care, the United States spends only 5 percent—a structural imbalance that undermines both health outcomes and economic productivity.²Improving Health Care Quality, “Increasing investment in primary care—lessons from states,” blog entry by Jordan Goldberg et al., The Commonwealth Fund, April 3, 2024. In many US cities, patients wait weeks for appointments; in some rural and underserved areas, delays may stretch to months.³Alyssa Reges, “Patient wait times in America: 9 things to know,” Becker’s Healthcare, June 9, 2017; Donavyn Coffey, “Primary care shortage reshaping how patients seek care,” Medscape Medical Review, April 29, 2024.

The future of primary care includes empowering patients, reimaging both the workforce itself and how care is delivered. Recruitment is one concern: 32 percent of all physicians practice primary care specialties (including internists, pediatrics, gerontology, and family medicine), but the field has struggled to recruit medical students.⁴State of the U.S. health care workforce, 2024, National Center for Health Workforce Analysis, November 2024; Michael Liu et al., “Medical education reform to preserve primary care in the USA,” Lancet Primary Care, August 2025, Volume 1, Number 2; Edward P. Hoffer, “Primary care in the United States: Past, present and future,” American Journal of Medicine, August 2024, Volume 137, Number 8. As discussed in the 2025 McKinsey Health Institute (MHI) report, “Heartbeat of health: Closing the healthcare workforce gap,” across specialties, the gap between population needs and system capacity in any country threatens its health and its economic vitality. In the United States, without bold investment in primary care—expanding the workforce, reducing burnout, modernizing delivery models, and aligning incentives—the United States risks declining productivity, rising preventable disease, and deepening inequities. In an ideal state, patients can prioritize primary and preventive care as part of their daily lives, have access to the care they need beyond traditional referral pathways, and ultimately support primary care clinicians’ efforts to address patient needs.

In this analysis, MHI, in collaboration with West Health, models the true demand for primary care based on condition prevalence and need, compared with the projected capacity across physicians, nurse practitioners, and physician assistants through 2050 (see sidebar, “About MHI and West Health collaboration”).⁵OB-GYN and pediatrics excluded from analysis. This model assumes current standards of care quality as the basis for calculating need, while acknowledging that there may be room for improvement in primary care quality. This could include an increased proportion of visit time spent with the patient, more substantial support, and additional resources for primary care clinicians. The goal of this model is to help quantify the magnitude of the challenges the US primary care ecosystem faces today, illuminate potential paths forward, and help us to reimagine what primary healthcare could look like in the future. While many of these solutions have been discussed by primary care physicians themselves and the broader healthcare industry, this analysis offers a visually interactive way to explore the data at a state level and to explore application of solutions.

The case for action: Strengthening primary care to protect health and economic resilience

When people cannot receive timely, continuous primary care, the consequences cascade across the health system—worsening outcomes, increasing provider burden, and driving avoidable healthcare spending.⁶Dilara Sonmez, George Weyer, and Daniel Adelman, “Primary care continuity, frequency, and regularity associated with Medicare savings,” JAMA Network Open, 2023, Volume 6, Number 8; Sven Göran Engström et al., “Personal GP continuity improves healthcare outcomes in primary care populations: A systematic review,” British Journal of General Practice, July 2025, Volume 75, Number 757; Anders Prior et al., “Continuity of care in general practice and patient outcomes in Denmark: A population-based cohort study,” Lancet Primary Care, August 2025, Volume 1, Number 2. Conditions such as uncontrolled diabetes, respiratory illness, and cardiovascular disease often progress to crisis when early primary care access could have prevented the need for higher acuity care. In 2017 alone, 3.5 million potentially preventable US adult inpatient stays cost approximately $33.7 billion.⁷Kimberly W. McDermott and H. Joanna Jiang, Characteristics and costs of potentially preventable inpatient stays, 2017, Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Statistical Brief Number 259, June 2020.

Access to affordable, effective primary care can interrupt this cycle. By managing chronic conditions, offering preventive care, and addressing emerging health needs before they escalate, primary care clinicians could reduce reliance on expensive emergency and inpatient services, improving patient lives while easing system-wide pressure.⁸An average visit to a primary care physician for mental and substance-use disorder may cost around $200, based on our model; an emergency department visit for mental and substance use may cost around $600. Zeynal Karaca and Brian J. Moore, Costs of emergency department visits for mental and substance use disorders in the United States, 2017, Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project, Statistical Brief Number 257, May 2020.

Innovating in primary care to address access and capacity challenges will require investments not just in traditional clinical infrastructure but also in enabling technologies and new care models that connect patients and clinicians seamlessly across settings. There is a critical window of opportunity for action: As more groundbreaking studies and research activities in diseases and conditions indicate, primary care is well equipped to be the first point of care delivery.⁹“Primary care,” American Academy of Family Physicians, accessed December 19, 2025. Beyond primary care capacity, there is an important question of primary care quality, and what more could be done to elevate best-in-class care models.

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While the above includes some scenarios on primary care, for a more comprehensive list of interventions in the health space, see the McKinsey Health Institute report, “Health of nations: Stronger health, stronger economies.”

Please see the technical appendix for more details on the methodology, data sources, and limitations.

To narrow the gap between the needs and access of patients, stakeholders across the healthcare ecosystem—policymakers, payers, providers, and innovators—can consider how to increase investment into primary care. Additionally, action requires committing to redesigning care models to better meet patients where they are and building a workforce equipped for the future. The cost of inaction is clear: widening inequities, avoidable disease burden, and escalating system strain. The opportunity, however, is equally compelling—a more resilient, equitable health system anchored in strong, accessible primary care.”