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February 12, 2026
Blog Post
Yalda Jabbarpour
Mar 22, 2024
Mar 6, 2023
Back to The States of Health
Visit the Primary Care Scorecard Dashboard — co-funded by the Milbank Memorial Fund and The Physicians Foundation and developed by the Robert Graham Center and HealthLandscape — to review, compare and export data on key primary care indicators for the nation and across states as the data were available.
The 2026 Primary Care Scorecard data show incremental, but fragile, gains in the primary care workforce and training pipeline. Financing for primary care continues to stagnate, with national spending levels largely unchanged and far below what is needed. There was considerable state variability for primary care spending and for primary care workforce density.
The data dashboard, which is updated annually, tracks the state of primary care in the United States across measures of primary care financing, access, workforce, training, and research investment.
As in previous years, the goal of the Scorecard — which is co-sponsored by the Milbank Memorial Fund and the Physicians Foundation and developed by the Robert Graham Center and HealthLandscape — is to provide policymakers, health system leaders, and the broader primary care community with actionable data. (It is important to note that shifting data availability required several adjustments to our approach this year.) Relatedly, our first Health of US Primary Care thematic report offers a deep dive into a primary care’s role in the prevention and management of chronic disease.
Nationally, primary care spending as a share of total health care spending remains low with only marginal movement. While we analyzed the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) data for continuity with previous years, this year we also included analyses using Health Care Cost Institute (HCCI) data for Medicare and commercial spending because these data were available for more states than MEPS. The HCCI Medicare dataset includes 100% of Medicare claims, and the commercial claims data covers one-third of the employer-sponsored population.
National MEPS data show a slight decrease in national overall spending under the narrow definition of primary care, which includes only physicians, dropping from 4.6% in 2022 to 4.5% in 2023. Commercial spending experienced a notable drop between 2022 and 2023 — from 5.5% to 4.9%. Conversely, Medicare and Medicaid spending increased slightly, with Medicare rising from 3.4% to 3.7% and Medicaid from 4.3% to 4.7% between 2022 and 2023. (See Figure 1.)
The broad definition of primary care spending — which includes nurse practitioners (NPs) and physician associates (PAs) in any outpatient specialty, behavioral health clinicians, and obstetricians/gynecologists — shows a similar trend in MEPS, with a decline from 13% of total health care spending in 2022 to 12% in 2023. This drop was driven mostly by commercial spending, which declined from 14.7% to 13.3%, while Medicare and Medicaid spending decreased only minimally. Medicare moved from 8.5% to 8.3% and Medicaid moved from 13.9% to 13.4%.
National-level narrow-definition estimates for Medicare and commercial spend using HCCI data align closely with MEPS, differing by roughly a percentage point for commercial and half a percentage point for Medicare — likely reflecting that HCCI data are available for more states (all states for Medicare and 44 for commercial), while MEPS covered only 29 states. HCCI data also allowed rural–urban comparisons, showing higher primary care spending as a share of total health care spending in rural ZIP codes, driven primarily by lower total health care spending in rural areas.
State HCCI data for both the narrow and broad definitions of spend show wide variability for commercial and Medicare spending. For the narrow definition, primary care spending in the commercial sector ranged from a high of 6.5% in Vermont to a low of 1.5% in Alaska. For the Medicare population, it ranged from a high of 7.4% in Nebraska to a low of 2.7% in New York. For the broad definition, primary care spending in the commercial population ranged from a high of 12.5% in Iowa to a low of 3.8% in Alaska, and for the Medicare population, it ranged from a high 13.6% in Iowa to a low of 4.6% in California.
National performance on our access measure using MEPS presents a mixed picture. Among adults, the share reporting no usual source of care1 remained stable in 2023 at 29.7% (down slightly from 30.9%). For children, however, the percentage without a usual source of care continued to rise, reaching 13.9% in 2023 compared with 12.4% the prior year.
Because of the lack of state-level MEPS data, this year we also analyzed data from the Behavioral Risk Factor Surveillance System (BFSS) for adults and the National Survey of Children’s Health (NSCH) for children.
Using BRFSS, we see a similar trend but lower percentages in adults reporting no usual source of care than we do in MEPS. Using NSCH, we see a fall in the percentage of children without a usual source of care from 26.6% in 2022, to 25.7% in 2023. Differences in survey questions likely account for discrepancies among the data sources.
Since our emphasis is on primary care as the usual source of care, the MEPS questionnaire is most suitable for our needs because it excludes the emergency department as a usual source of care. We are hopeful that MEPS will eventually provide state-level data again.
Workforce measures show slight but encouraging improvements. Physician primary care workforce levels remained stable at 67 primary care physicians per 100,000 population in 2023, with 26% of all physicians working in primary care. While there is no true target for the density of primary care physicians, other economically developed countries with better health outcomes average at around 80 per 100,000. Our closest neighbor, Canada, has around 120 family physicians per 100,000 population. Total primary care clinician (inclusive of physicians, NPs, and PAs) supply increased to 106 primary care clinicians per 100,000 population after a dip the previous year. Primary care NP supply increased from 26 to 28 per 100,000, with 29% of all NPs practicing in primary care, down from the high of 34% in 2021. Primary care PA supply increased from 10.41 to 11.13 per 100,000, with 24% of all PAs working in primary care, down from a peak of 29% in 2021.
There is great state variability in workforce density, with Vermont having the highest number of primary care clinicians per 100,000 population at 169.7. Interestingly, Vermont also had the lowest share of children without a usual source of care (14.4%) and is among the states with the lowest share of adults without a usual source of care (15%). Nevada had the lowest number of primary care clinicians per 100,000 at 86.9 and is among the state with the highest percentage of people reporting no usual source of care (31% of adults and 36% of children). These numbers suggest that while access to care is multifactorial, availability of the workforce is a major contributor.
Performance on workforce pipeline indicators also improved slightly. The proportion of new physicians entering primary care rose from 18.6% to 22% in 2023, an encouraging development if the trend continues. The number of primary care residents per 100,000 population increased very slightly from 17.23 to 17.73 — the highest level in a decade. This uptick is encouraging, although its impact is likely limited by the persistent trend of internal medicine and pediatric residents subspecializing. Community-based training — which is strongly associated with practicing in primary care and in underserved settings — continued its upward trajectory. Residents in Teaching Health Centers or Rural Training Tracks rose to 5.8% in 2024, up from 5.1% the previous year and more than double the rate a decade ago.
In contrast to some of the improvements seen in training, research funding for primary care remains low. In 2024, federal research support fell to a new low of $115 million, representing just 0.31% of total federal research funding. Given recent federal budget changes to research in 2025, this figure will likely decline further next year.
While this year’s Scorecard dashboard reveals familiar themes of underinvestment, workforce strain, and lack of access to a usual source of care, it shows small but positive movement in the primary care workforce and training pipeline. Without meaningful investment in primary care, however, the modest workforce improvements we observed are unlikely to persist. As we warned in last year’s report, The Cost of Neglect, market forces will continue to pull physicians, NPs, and PAs away from primary care toward more lucrative specialties unless primary care is appropriately valued and funded.
Usual source of care in MEPS is based on an affirmative answer to the following question: Is there a particular doctor’s office, clinic, health center, or other place that {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health? Note, anyone who answered yes but noted that the ER was their usual source of care was included in the no usual source of care count.
For BRFSS, usual source of care is based on an affirmative answer to the following question: Do you have one person you think of as your personal doctor or health care provider? (If ´No´ ask ´Is there more than one or is there no person who you think of as your personal doctor or health care provider? In 2021, this question changed to: Do you have one person or a group of doctors that you think of as your personal health care provider?
For NSCH, usual source of care is based on an affirmative answer to the following question: Does this child have a place that they usually go to first when they are sick or a caregiver needs advice about their health?
