Primary Care Needs a Triple Double: A Call to Action

For too long, primary care has been viewed as a nice-to-have part of the health care system. But it’s not an add-on. It’s the core of any high-performing health system, and the evidence supporting its impact on community wellbeing is undeniable. Primary care is the only part of the health care system in which investment in it directly produces better health outcomes for all, including longer life expectancy at a sustainable cost. One study has shown that for every 10 additional primary care clinicians per 100,000 people, life expectancy increases at the county level in the United States. That means that the number of primary care clinicians in any given community can add years to the lives of those who live there. Yet, it continues to be underfunded, understaffed, and undervalued, leaving only two-thirds of Americans with access to a primary care team that knows and cares for them.

Health care should not just be about treating illness. It should be about preventing it, building long-term healing relationships, and improving overall health outcomes. So, when we talk about how to extend life expectancy and improve health at a sustainable cost, the answer is simple: double down on primary care.

The “Triple Double” Goal: A Bold Vision for Primary Care

If we’re going to make the necessary changes, we need a bold vision. I’m calling this vision a “triple double” for primary care by 2030. In basketball, a triple double refers to a player achieving double digits in three of the five core statistical categories — points, rebounds, assists, blocks, or steals. It’s a big accomplishment and happens less than 5% of the time. More importantly, it denotes success: The team who has a player with a triple double wins more than 75% of the games they play. That’s a major advantage.

So, if we want to enable primary care to achieve the success that we know it can, we need a triple double for primary care by 2030. That would entail:

1. Doubling the primary care spend from 5% to 10% of total health care expenditures.
   And we can’t just increase the level. We also need to change the form of payment (away from fee for service toward capitation), as well as follow the flow of funds to make sure they reach the primary care teams that care for communities. We know this is possible — just look at what Rhode Island did to double primary care spend in five years while keeping costs budget neutral. 
   
2. Doubling the overall share of Americans served annually by community health centers (CHCs) from 10% to 20%.
   Why CHCs? Because they are the best-performing part of our primary care system. They deliver high-quality, cost-effective care to some of the most underserved communities in the country, where the need for primary care is often greatest. But right now, CHCs are operating at capacity, and they’re stretched thin. To meet the needs of a growing population, we must invest in expanding CHC infrastructure, workforce, and funding. With the right expanded resources, we can increase access to high-quality care for millions more Americans, especially those who are most vulnerable, including low-income families and rural populations.
   
3. Doubling the proportion of post-graduate physicians choosing primary care from 20% to 40%.
   One of the most pressing challenges in primary care today is the lack of doctors entering the field. Less than 20% of new physicians are entering primary care, which is simply not sustainable if we want to meet the needs of the nation’s growing and aging population. The solution? We need to double the proportion of new physicians entering primary care from 20% to 40%. To achieve this goal, we need a systemic overhaul of how we fund medical education. States that provide more funding for primary care trainees, especially in community-based settings through teaching health centers, are seeing more new doctors entering the primary care field. To see this shift on a national scale, we need to redirect more resources toward medical school programs that train primary care doctors, nurse practitioners, physician assistants, and other key members of the primary care team.
   

These goals are ambitious, but they’re achievable. The Triple Double is possible, but only if we make it a priority. To see how close your state is to these three goals, see the November 2025 version of the companion Triple Double primer.

Background

Primary Care Gets Pennies on the Dollar. Today, primary care in the United States receives only 3-6% of total health care expenditures, meaning that just three to six cents on every dollar spent on health care go toward primary care. Despite the fact that 35% of health care visits happen in primary care settings, only a small fraction of the money flows to the people who are actually providing that care.

This financial model is not only broken, it’s also inhibiting our ability to serve communities. Primary care clinicians work tirelessly to care for all people, and especially the most vulnerable. We don’t just treat colds and adjust blood pressure medicines. Rather, we handle complex undiagnosed illness, coordinate care across multiple specialties and after hospitalization, address social drivers of health, manage chronic conditions, and integrate behavioral health. All while getting paid pennies on the dollar.

The current fee-for-service system doesn’t work and simply rewards volume at a discounted level. The more visits you churn out, the more money you make. But this model doesn’t foster the type of continuous, coordinated, empathetic care that we know works. Effective primary care is about teams in relationship with the communities they serve. It’s about multidisciplinary care that integrates medical, behavioral, and social health. And yet, we’re stuck in a system that rewards the number of individual visits, instead of a system that supports comprehensive, team-based, whole-person care.

As a result of this mismatch between payment and function, primary care clinicians are increasingly cutting back their hours, going to concierge care for those who can pay for it, or leaving the field entirely, while fewer medical students are entering it in the first place.

Fewer Clinicians, Rising Demand. Currently, almost 30% of people in the US don’t have a consistent primary care clinician. At the same time, the number of primary care clinicians per capita is falling. We’ve seen an increase in nurse practitioners and physician assistants offering primary care, but even those numbers have plateaued as these essential roles are burdened by the same burnout, long hours, and pressures of a system that doesn’t reward primary care that affect physicians.

Even more concerning is that fewer medical students are choosing to specialize in primary care. Less than 20% of new physicians are entering primary care each year. This flow is not enough to sustain an effective primary care system in our country. In other countries, where primary care is viewed as the backbone of health care systems and funded accordingly, we see the share of doctors entering primary care is closer to 50 even 70 percent. The US is lagging far behind.

Rethinking Graduate Medical Education. This workforce shortage is exacerbated by graduate medical education funding that is heavily skewed toward training specialists in academic hospital systems. States that receive more funding for medical education tend to produce more specialists, and fewer primary care clinicians. The result is an oversupply of specialists and an undersupply of primary care physicians — fewer people to do the critical work of keeping people healthy before they need a specialist or hospital. This isn’t to say that specialists are as important — they have a critical role to play in the health care system. For far too long, though, we have taken primary care for granted and not considered the dangers. Primary care, like oxygen, only often gets noticed in its absence.

Current medical school funding models are contributing to an unbalanced health care workforce that can’t keep up with the needs of our communities. If we want more primary care clinicians, we have to make it a fiscal priority in our funding and training models.

The Time for Action Is Now

We have a real opportunity to change the course of health care in the United States. But this change won’t come on its own. It will take all of us — patients, payers, policymakers, clinicians, and communities — coming together and demanding more for primary care that works for them. This isn’t just about more money for primary care’s pockets; it’s about ensuring that the communities we serve get the care they need and deserve.

As we move toward 2030, let’s be audacious. Let’s go for a primary care triple double by doubling primary care spending, doubling the share of patients cared for by CHCs, and doubling the percentage of new physicians entering primary care. We can’t afford to wait. The health of our communities, and the future of primary care, depend on it.