A recent AARP bulletin story by Dr. Howard Zucker asks, "Where have all the doctors gone?"
Historically-driven physician shortages, inequitable pay between primary care and other specialties, and an aging and increasingly complex patient population are not only exacerbating the lack of physicians, but corporate ownership of healthcare and administrative burdens are pushing existing physicians out.
Recent surveys and research provide perspective on the current physician shortage, particularly in primary care. Below, we offer six actionable strategies that health plans and providers can use to ease the immense pressure on primary care physicians.
What’s causing the primary care crisis?
Reason #1: There are not enough new physicians
There's been a chronic physician shortage since the 1980s that changing medical school admissions or increasing residency slots hasn't overcome. Pay discrepancies between primary care specialties and others drive new physicians away from choosing Family Medicine, Internal Medicine, or Geriatrics.
Figure 1: Physician shortage estimates. Sources: AARP cover story Jan. 2025 - US Bureau of Labor Statistics and the Association of American Medical Colleges (AAMC).
Reason #2: Existing physicians are leaving patient care, retiring, or cutting back hours
Surveys conducted in 2023 with more than 33,000 full-time physicians uncovered that as a direct result of the physician shortage, the majority of physicians said they have experienced:
- 67% overwork or burnout
- 60% diminished job satisfaction
- 54% deteriorating workplace culture
- 41% unsustainable patient caseloads
- 39% concern about medical errors
- 37% outbursts or threats from patients
Half of those surveyed were having thoughts about leaving clinical practice altogether.
Figure 2 highlights the number of existing physicians who are cutting back on patient care or leaving the profession. Sources: AARP cover story Jan. 2025 - American Medical Association (AMA) and Mayo Clinic study.
Based on these shifts, the Mayo study estimates that in the next two years, the physician workforce would be reduced by the equivalent of 20,334 physicians. This loss would negate the increase from all medical school graduating classes combined.
Reason #3: Inequitable and inadequate primary care physician pay
Primary care physicians aren't earning enough. The Centers for Medicare and Medicaid Services (CMS) has cut physician pay for five consecutive years. Nearly 62% of physicians believe that their compensation does not reflect the level of expertise and effort required in their role.
Preventive Medicine, Internal Medicine, Family Medicine, and Geriatrics were among the 20 specialties with the lowest average annual compensation in 2023. And, while Internal Medicine is one of the specialties with the lowest pay gap, women still make far less than their male counterparts.
Reason #4: The senior population is living longer with more chronic conditions
Primary care is in greater demand as the shortage grows. According to the Association of American Medical Colleges (AAMC), by 2036, the number of adults over 65 will increase by 34%. Those over 75 will increase by 55%.
Of physicians surveyed, 86% are concerned about US healthcare’s ability to care for this aging population.
Reason #5: Private practices can’t survive with cost increases and pay reductions
According to the Physician Advocacy Institute, 80% of all physicians are employed by hospitals or corporations, which equals a 200% increase in a decade. A 2024 survey in JAMA found that 61% of physicians found private equity ownership unfavorable for healthcare.
Providers are experiencing more problems with prior authorization requirements and longer reimbursement times.
Of the physicians surveyed, 97% have seen delays or denials for necessary patient care due to prior authorization requirements, and 67% saw reimbursement times lengthening in 2024.
Reason #6: Physician burnout and suicide rates continue to rise
The impact of all these factors is heightened physician burnout and suicide. In addition to 67% of surveyed physicians experiencing burnout and overwork, more than 300 physicians die every year from suicide. This is double the rate within the general population.
Part of the stress physicians feel is that patient health and care is suffering, including:
- 87% of physicians believe that patients have experienced longer wait times due to the physician shortage
- 75% believe patients have experienced diminished healthcare access
- 75% believe patients have experienced worse healthcare disparities
- 70% believe patients have experienced delayed treatment or medical intervention
Six strategies health plans and providers can take now
Some of the changes needed to reverse the physician shortage will require legislative interventions, budgetary commitments through CMS, and advocacy through the AMA and other professional organizations.
Health plans and providers, however, have the power and opportunity to positively impact physician retention through available CMS programs and technologies. Here are six strategies to address this issue.
What can health plans do now?
Fix pre-authorization
Since 2022, research into the prior authorization requirements and response times of Medicare Advantage and Medicaid managed care plans has highlighted the ongoing challenges providers face. A growing number of states have passed laws to establish prior authorization standards across almost all CMS insurance programs.
And, in light of CMS’s 2024 electronic prior authorization rule, MA plans have faster response time requirements.
An AMA physician survey in 2022 uncovered the real-world impact of onerous prior authorization requirements:
- 86% said that prior authorizations resulted in increased use of healthcare resources, leading to waste rather than the cost savings claimed by insurers
- 66% reported that prior authorization requirements led to either diversion to ineffective initial treatments or additional office visits
- Studies show the average cost for prior authorization approval on primary care practices ranged from $2,161 to $3,430 annually per full-time physician
But legislation is just one way to require change. Health plans have a duty to their members and provider networks to make care accessible and affordable according to their coverage rules.
To improve prior authorization and make it easier for providers to deliver covered services to their patients, health plans can:
- Streamline the preauthorization process by using electronic systems
- Provide clear and transparent criteria for approvals
- Expedite urgent requests
- Reduce unnecessary prior authorization requirements
- Offer real-time status updates
- Collaborate with providers to identify areas for improvement
- Implement robust data analytics to monitor the effectiveness of their prior authorization practices
Taking these steps could ensure timely responses to requests while minimizing administrative burdens on providers and their patients.
Health plans can support providers and keep more physicians in practice by improving sluggish response times, reducing and streamlining preauthorization requirements, and instituting more peer-to-peer reviews.
Support primary care providers through collaborative care management
Health plans have a unique opportunity to collaborate with providers, particularly those in primary care.
Through team-based care management programs such as Chronic Care Management (CCM) or Remote Patient Monitoring (RPM), health plans can provide the technology and claims data while providers can engage patients and analyze health data.
Figure 3 outlines the unique strengths that health plans and providers bring to care management collaboration.
Through collaborative care management, health plans and providers can leverage data, experiences, relationships, technology, and capabilities to improve outcomes and control costs. These synergies can also relieve providers' administrative burdens while driving deeper member engagement.
What can providers and physician-leaders do now?
Leverage Medicare care management programs as a new approach to chronic care
Traditional primary care has increasingly focused on chronic care as acute and urgent care needs are being addressed in other healthcare channels. The typical approach to chronic disease management is evolving beyond periodic doctor's appointments to help patients with self-management and a more holistic approach to social risks and barriers to patients achieving health goals.
Medicare care management programs enable ongoing and remote touchpoints and patient engagement opportunities. Through CCM, Principal Care Management, Advanced Primary Care Management and others, providers can reduce the workload of overseeing so many patients with chronic diseases in a more manageable and systematic way.
Use care management services to build out a non-physician practitioner team
Providers can use care management services to build out a team of non-physician practitioners.
This can include nurse practitioners, physician assistants, certified nurse midwives, and clinical nurse specialists. Even collaboration with pharmacists can make care management a viable complement to physician-driven care.
Hiring a care manager can be a critical first step to alleviating physician burnout and launching a viable care management program that yields positive ROI.
Leverage Medicare Annual Wellness Visits
In addition to building a team-based care management service, focusing on preventive care through an Annual Wellness Visit (AWV) can provide tremendous value to patients and overworked physicians.
While AWV billing must be submitted under a provider's NPI number, clinical staff can administer most of the assessment, saving physicians time and involvement.
Not only can AWV services enhance patient engagement and practice revenue, but they also offer an opportunity to head off problems before they become more complicated. AWVs can introduce patients to care management services that could help with chronic disease oversight.
Invest in technology and AI to streamline administrative tasks
According to the physician survey highlighted earlier, physicians have distinct views on what would help alleviate the shortage and keep practicing physicians in the profession.
Seventy-five percent of physicians believe that reducing administrative burdens would meaningfully improve physician overwork and burnout.
Technology and artificial intelligence can reduce not only the physician's workload, but it can equip the care management team to deliver more personalized chronic and preventive care for more patients.
ThoroughCare streamlines workflow for care teams
While many of the issues physicians face, and those causing the current physician shortage, will require new national approaches to reimbursement, training, and care team functions - there are many strategies health plans and provider organizations can use to keep good physicians caring for patients at the top of their license.
ThoroughCare gives providers the tools and support to make care management effective.
We help providers build programs or scale existing services based on their specific needs. ThoroughCare supports a comprehensive software platform, clinical expertise to optimize workflows, and assistance with data and reporting to improve quality.
We simplify the process, so providers can focus on engaging patients. ThoroughCare offers:
- Comprehensive care planning tools
- Evidence-based assessments (lifestyle, health risks, behavioral conditions, SDOH)
- Automated billing code assignment with audit trail
- Data integration across EHRs, HIEs, remote devices, and advance care plans
- Analytics to report on care performance and operations
Key questions answered
What is causing the physician shortage?
A number of current and historical factors are causing the current and future physician shortage, particularly in primary care specialties like Internal Medicine, Family Medicine, and Geriatrics, including:
- Less medical students choosing primary care specialties
- Fewer physicians going into direct patient care
- Physicians retiring or leaving the profession
- More primary care practices and provider organizations are owned by corporate entities
- Physicians are experiencing burnout due to caseloads, administrative, and financial burdens
- Primary care pay is not commensurate with experience and skill
What can health plans and providers do to mitigate the physician shortage?
Health plans can help providers by reducing complex and confusing prior authorization requirements and streamlining the preauthorization process. This could decrease barriers to care, help physicians deliver needed care more quickly and efficiently, and reduce burdensome administrative tasks.
Health plans can also collaborate with physicians through care management programs like Chronic Care Management and Remote Patient Monitoring. By providing support through experience, technology, and data, health plans can enable chronic care and preventive care models and revenue for physicians.
Providers have a host of Medicare care management programs available to them, including Chronic Care Management and Annual Wellness Visits. These reimbursable programs support chronic care management and preventive care while also helping physicians build non-physician practitioner teams to provide more patient-centered care at scale.