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29 Who Cares about Primary Care? Young Adults and the Primary Care Shortage

Calvin Judd

Author Biography

Calvin is a junior at Utah State University and is studying biochemistry. Although he spends a lot of time learning about chemistry and biology, nothing can replace his love of writing. He hopes to study medicine one day, provided he can overcome all the challenges along the way. Calvin has been married for almost 2 years and his favorite thing to do is spend time with his wife.

Writing Reflection

Because of my interest in medicine, I’ve had a lot of exposure to the medical field, and I’ve come to learn that it is far more convoluted than I would have ever expected. I think it is important to spread awareness of the issues facing the U.S. health care industry because those issues directly affect the health of everyone in the U.S.. Spending 3 years at Utah State surrounded by my hard working peers has given me a lot of faith in my generation. I look up to my peers, and I wanted them to be aware of their potential to create meaningful change in this area.

This essay was composed in March 2023 and uses MLA documentation.


As a young adult, I’m familiar with the many challenges faced by our generation. I can barely afford rent in my apartment, and housing prices make me think I’ll never be able to afford a home. I’m alarmed by the social, environmental, and political problems that I’m exposed to almost daily, but my efforts to contribute to their solutions seem trivial at best. I’m astounded by the high cost of healthcare and the outrageous sums that are requested of the sick and dying. My experiences largely align with those challenges that researchers have identified as being especially impactful for my generation.  A top consulting firm has found that young adults admit to a high degree of economic uncertainty, especially regarding economic milestones such as homebuying (Dua et al.). The media company Forbes finds that social issues are “top of mind” for Millennials and members of Generation Z (Deloitte). A private philanthropy organization describes healthcare as a “core issue” for Generation Z (The Annie E. Casey Foundation).

Generation Z, or Gen Z, refers to individuals born after the year 1996 (Dimock). Like any generation entering adulthood, its members face quite a few challenges. I would like to add to that list of challenges by asking today’s young adults to begin to focus on the problems faced by the United States healthcare system. There are numerous issues currently facing the healthcare industry, enough that you could write a book about them. Those who have an interest in healthcare may already be aware of some of these challenges. One challenge in particular that deserves more attention is the ongoing shortage of primary healthcare providers. Addressing this shortage has the potential to improve health and decrease healthcare spending, and I believe it is a problem that today’s young adults are especially equipped to handle.

What is primary care? If you ask the American Academy of Family Physicians, they will say that it is “the provision of integrated, accessible health care services by physicians and their health care teams who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community” (“Primary Care”). Although this definition is lengthy, I think it’s important to be aware of the definition of primary care as described by those who practice it. I would simplify this definition by saying that primary care is care you get from your family doctor, pediatrician, or OB/GYN. Think going in for a routine check-up or calling in to refill a long-standing prescription. There are a number of sources that express concern about an ongoing and worsening shortage of primary care providers, from medical organizations to peer-reviewed articles, to media companies, to medical professionals themselves. A 2015 article published in the Annals of Family Medicine predicted a shortage of 44,000 primary care physicians by the year 2035 (Petterson et al.). A study published five years later by the journal Human Resources for Health, quantified the primary care shortage at 45,400 physicians (Zhang et al.). It is worth noting that this later study was published February of 2020, before the Covid-19 pandemic exacerbated the primary care shortage on several levels. These studies are two examples drawn from a large body of research regarding the shortage of primary care providers. While nearly all of the studies differ slightly in their numerical estimates, I think it is worth pointing out that one study predicted the shortage would reach 44,000 in the year 2035, while another study found that we had already reached that figure by February of 2020. The need to address the shortage becomes clear when considering the rapid worsening of the shortage seen in these numerical estimates.

Now, as a young adult, I might be inclined to ask myself why this shortage is such a big deal. The last doctor I visited was not a primary care provider, but an orthopedic specialist. He was very knowledgeable about my specific problem and quite qualified to treat it. In fact, I’ll admit that I haven’t seen a primary care doctor in almost six years. Research suggests that my situation is not unique. A study by the Canadian Medical Association found that individuals ages 18-34 are the least likely of all age groups to have a family doctor (Glauser). I acknowledge that younger generations may not place primary care at the top of their priorities list, it may not even be on the list. The lack of interest in primary care on the part of young adults is likely due to their having relatively few health needs compared to older members of the population. However, I believe it is a topic that deserves their attention. In the following paragraphs I address three reasons why the field and the shortage it faces deserve the attention of young adults.

The primary care shortage is problematic because it leads to poorer health at a higher cost. An American pediatrician named Barbara Starfield spent 50 years practicing and researching primary care at Johns Hopkins University (Fleming). Her 2010 publication draws on this body of research. It is a comparison of the healthcare systems of the United States and Canada and the overall health of these two countries. Starfield points out that these two countries are very similar in terms of development, industry, and education, but that they differ significantly when it comes to health. Canada significantly outranks the United States in 10 out of the twelve measurements used internationally to assess a nation’s health. Starfield states that this finding is “consistent with [Canada’s] much higher primary care services rating and ranking”. She also points out that countries with a primary care system comparable to Canada have similarly superior health outcomes. What can we learn from this? Starfield’s findings demonstrate a correlation between adequate primary care and improved health outcomes. The study repeatedly finds this correlation when comparing the health of the United States to similarly developed countries, suggesting that the health disparity between the otherwise similar countries is due in part to the increased emphasis on and access to primary care in the healthier countries. This suggests that, in addition to other more menial drawbacks, like a months-long waiting list for a doctor’s appointment, the current primary care shortage in the United States leads to a significant decrease in health for the people who live here. Studies conducted by other researchers have led to similar conclusions. Physician Ada Stewart states that Americans experience worse health outcomes because our healthcare system “discourages health maintenance through primary care”. In other words, the U.S. healthcare system does not encourage people to use healthcare to stay healthy, but rather to use healthcare only after they get sick. Waiting to seek care until sick can give health issues time to worsen and become more difficult to treat. It can also mean that chronic health issues, like high blood pressure or high cholesterol, may not be diagnosed until they begin to have severe health effects. Treating preventable, severe conditions is less beneficial to health than preventing those conditions in the first place. Because primary care is important for preventative treatment, it follows that a primary care shortage would negatively impact national health outcomes. This is addressed further in a study by a North Dakota research group, which found that primary care utilization led to increased implementation of preventative health measures (Hostetter et al.). This suggests that people who visited with a primary care provider were more likely to get blood tests, imaging, and similar measures to screen for diseases and treat them early on, rather than waiting until falling ill to seek treatment. This again highlights the effectiveness of primary care at preventing disease and improving health, leading to better overall health outcomes. Overall, I find the evidence relating primary care usage to better health to be quite convincing. Unfortunately, this suggests that the primary care shortage we are experiencing in the U.S. will negatively impact our health, and the prevalence of poor health is therefore likely to increase until the primary care shortage is addressed. The potential to improve health is one factor of the primary care shortage that I hope will motivate young adults, especially those interested in healthcare, to place greater attention on the shortage and possible solutions.

Improved health is not the only benefit of a healthcare system that emphasizes primary care. The same researchers whose findings relate primary care usage to better health also state that the lack of primary care in the U.S. leads to increased healthcare spending. Dr. Starfield’s study reports that, in addition to having better health than the United States, Canada and other developed countries spend significantly less on healthcare. In fact, her study is one of many that show the U.S spends more on healthcare than any other developed country (Blank). Dr. Stewart’s paper reports similar findings, stating that not only does the US demonstrate statistically poorer health than other developed countries, but it spends more than twice as much on healthcare. Both authors posit that limited access to primary care, failure to emphasize primary care, and shortage of primary care providers play a role in this increased spending. Just as the primary care shortage contributes to poor health outcomes through a lack of preventative care, so does it increase healthcare costs by encouraging treatment rather than prevention of disease. Chronic conditions like high blood pressure and high cholesterol are not only less treatable when they become severe, but also more expensive. Unfortunately, the preventative role of primary care is inhibited due to the current primary care shortage, and the cost of healthcare continues to increase. Given that many members of Generation Z “can only afford care through the affordable care act and Medicaid expansion” (The Annie E. Casey Foundation), this high cost is becoming a prevalent issue for Gen Z, and they have not been silent on the issue. For an example of how young adults feel about the high cost of healthcare, take a look at the following collection of memes.

If better health outcomes were not sufficiently motivating for the largely healthy members of Gen Z to begin addressing the primary care shortage, I would hope that the potential to decrease healthcare spending by addressing the shortage would provide the necessary motivation. As demonstrated by these images, prohibitively expensive healthcare can be life-threatening.

We’ve talked in depth about why the primary care shortage is a problem, but what is causing the shortage, and what can be done to address it? This brings me to some personal experiences that have fostered my interest in this topic. As you may have guessed, I have an interest in primary care. I once expressed this interest to a physician, and his immediate response was “You don’t want to go into primary care. Primary care is helping people manage their diabetes, getting old people to take their medication when they don’t want to, that kind of thing.” Following this conversation, I tried to remain optimistic about primary care, but as you might imagine, I came away from the experience somewhat deterred. My interest in healthcare and exposure to the healthcare field have allowed me to observe other, similar situations, such as a nurse shaking her head at the idea of a top performing medical student choosing to pursue primary care, or a surgeon’s frustrated remarks regarding the incompetence of primary care doctors. These situations taught me that, within the medical community, primary care is not an especially prestigious field. Indeed, a study by medical sociologist Joanna Brooks found evidence of “persistent hostility” against primary care trainees and stated that this hostility has become part of the “culture and structure of medical training”. When considering this research in combination with my own experiences, I find it likely that this hostility and disparagement contribute to the shortage of primary care physicians. Possibly due to its perceived lack of rigor compared to other fields such as surgery, the field of primary care is looked down on, and medical trainees opt for a less stigmatized and more prestigious career path. What can we do to change this? My hope would be that today’s young adults might help change this culture of hostility and disparagement. To young adults who are considering a career in healthcare, I would urge you to refrain from disparaging the field of primary care. As we have seen, it plays an important role in maintaining health and controlling healthcare costs. I focus on young adults in my request because I believe they are especially suited to the task. Research by a management and consulting firm finds that, when it comes to the workplace, Gen Z is especially concerned about the human element, and that they are looking for jobs where “everyone on the team is valued and appreciated” (Tulgan). Applied to the field of primary care, this attitude has the potential to address one of the causes of the primary care shortage: the stigmatization of those who make it a career. I would urge those young adults entering the medical field to change this harmful aspect of the culture and structure of medical training and maintain or even increase their desire for equity and inclusivity. Doing so can help address the primary care shortage, thereby improving health outcomes and curbing healthcare spending. However, it is important to realize that the causes of the primary care shortage go beyond that of disparagement of the profession, and there are other problems that young adults have the power to address.

Primary care experiences high rates of burnout, a factor that likely contributes to the shortage in this field. One physician describes burnout as “a combination of physical and emotional exhaustion that can lead to reduced effectiveness” (Berg). A position paper by the American Academy of Family Physicians states that burnout rates are significantly higher for family physicians compared to physicians in other specialties, and that this likely contributes to the shortage of primary care providers (“Family Physician Burnout”). Reasons for this skewed distribution of burnout among physicians are too numerous to discuss here, but I bring up the issue because I believe it is one that today’s young adults are capable of addressing. My own observations as a young adult tell me that those of my generation value self-care. This finding is reflected in a 2022 study at Stanford University, which finds that Generation Z values self-care (Katz).  Unfortunately, doctors are too frequently expected or required to ignore their own needs and, in some cases, their own wellbeing. Doctors can sometimes be seen as especially capable or high achieving, a stereotype propagated by the rigor of medical training. What many people fail to realize is that, despite this stereotype of hyper-capability, physicians are simply human. They get stressed out, just like everyone else. And as we have seen, they are by no means immune to burnout.  I believe that today’s young adults are equipped to make changes to this stereotype. For those that are interested in the field of healthcare, continuing to practice self-care despite the demands of your education has the potential to decrease burnout rates in the healthcare field. Sharing your opinion on the importance of caring for yourself can also help promote the needed change in preventing burnout. Addressing the problem of burnout can help to address the primary care shortage, thereby improving national health and managing healthcare costs. At this point, I’ve discussed disparagement and burnout as causal factors of the primary care shortage. There is one more cause of the shortage I would like to address, and it is related to government regulation regarding primary care.

Government regulation regarding primary care plays a role in exacerbating the primary care shortage, and, like disparagement and burnout, I believe it is a problem that young adults have the power to address. One example of government action contributing to the primary care shortage came with the Balanced Budget Act in 1997. This bill capped the amount of government funding for medical training, limiting the number of trainees that could enter primary care and other fields (Robeznieks). Twenty-six years later, the U.S population has grown by about 60 million, but government funding has remained stagnant at 1997 levels. A study by sociologist Robert Blank suggests that the U.S government has been conceived in a manner that favors the status quo, “especially on controversial issues like healthcare”. This means that not only is the primary care shortage made worse by some actions on the part of the government, but that the government itself is set up to perpetuate the problems it is causing. This problem is therefore a difficult one to resolve. However, I believe that today’s young adults have the ability to at least begin to address it. Research has shown that members of Gen Z are more likely than other generations to question rules and authority (Katz). Rather than maintaining long-established trends, members of Gen Z are likely to look at those trends with a critical eye and change them if necessary. This suggests that members of Gen Z can be effective at changing the government regulations that contribute to the healthcare shortage. I think a good place to start would be to update government funding for medical training to reflect the growing and aging U.S. population.

I have spoken quite a bit about this idea of a primary care shortage. Many of the sources I’ve consulted while researching this topic analyze this shortage, quantify it, and in general treat it as an established fact. However, there are other sources that deny the existence of a shortage of primary care doctors. An article published by Harvard Business Review is a good example of the arguments against the existence of a primary care shortage. Citing issues such as uneven distribution of primary care doctors, inefficiencies in how doctors spend their time, and inflexible care models, the authors suggest that we “stop panicking about a looming ‘shortage’” and state that if the current supply of primary care providers was used efficiently, their numbers would be sufficient (Kerns and Willis). I appreciate the points Kerns and Willis make in their article. They highlight the need for change to occur in the healthcare system, as opposed to the need to funnel more doctors into a poorly functioning system. In response to this I would point out that all-around implementation of “best, evidence-based practices”, as suggested by Kerns and Willis, would of course solve many problems, and likely have a significant positive impact on healthcare costs, access to healthcare, health outcomes, as well as other positive impacts. I am strongly in favor of implementing best, evidence-based practices, and I acknowledge that, if they were implemented, our current supply of primary care providers might well be sufficient. However, I would also argue that the solution presented by Kerns and Willis is akin to saying ‘let’s fix all the problems in our healthcare system and the primary care shortage will take care of itself along the way’. I agree that it is a possible solution, but I don’t think it is a feasible one, at least in the short term. I also think it is worth pointing out that the measures I have suggested would be relevant both in the presence and absence of a primary care shortage. Assuming there is no shortage of primary care providers, would it not still be beneficial to do away with the habit of primary care disparagement that has become a part of the culture of medical practice? Would encouraging self-care and decreasing burnout not be helpful in the absence or presence of a shortage? Would it not be beneficial to at least increase government funding proportionally to the increase in the population, especially when considering the fact that a higher population means more tax revenue for the government? The primary care shortage, acknowledged by some, refuted by others, is both a cause and a symptom of the overall struggles of the U.S. healthcare system. My aim is to bring awareness to the specific issue of the primary care shortage, and to show today’s young adults, those who are beginning to enter the workforce full-time, that they have the skillset needed to bring about meaningful change.

There are those who would argue that despite having the skillset to bring about meaningful change, today’s young adults are too financially motivated to have an effect on the primary care shortage. Some researchers suggest that Generation Z prioritizes earnings above other factors when seeking a job (Deichler), (The Annie E. Casey Foundation). In 2022, a medical reporter found that the annual salary of a primary care physician is about $100,000 less than that of other specialties (Murphey). It is likely that this decreased salary contributes to the primary care shortage, especially when considering that the average doctor graduates medical school $200,000 in debt. I acknowledge that because of the salary and other factors, the field of primary care will not appeal to everyone seeking a career in healthcare. However, I have encountered many people who are able and willing to accept a decreased salary in order to have a career they enjoy. My hope would be that those young adults who are entering the workforce, those who are interested in healthcare and have a sincere interest in the field of primary care, will not be deterred by the salary gap. I hope that the information I have presented here, the health benefits and cost benefits of addressing the primary care shortage, as well as solutions for some of its causes, can help those interested in primary care to see that it is worth their investment. I would also add that programs exist, such as loan forgiveness and scholarships, that can decrease the burden of debt for those pursuing a career in this underserved field.

If you have reached the end of this essay without losing interest, I congratulate you. This is a complicated topic, and despite the dense nature of some of my writing, I have only provided a limited discussion of this issue, which itself is only a small part of the many issues plaguing the U.S. healthcare system. I repeat my claim that the primary care shortage is a problem that deserves more attention than it is currently receiving. Addressing the primary care shortage has the potential to improve the overall health of the U.S. population and decrease the amount we spend on healthcare. I believe that today’s young adults are especially equipped to handle this problem. Their focus on equity and inclusivity can help decrease the stigma and disparagement experienced by those in the primary care field. The value young adults place on self-care can help mitigate the high rates of burnout experienced by primary care providers. The willingness of today’s young adults to challenge the status quo provides hope that government regulations regarding medical training might be updated to better suit today’s needs. These solutions are relevant regardless of whether the primary care shortage is due to inefficiencies in the system or an actual lack of healthcare providers. And although research suggests that today’s young adults may be too financially preoccupied to choose less lucrative career options, I have observed enough counter examples to this data to convince me that there are those who are both willing and able to accept a lower salary in order to have the career they desire. I believe that as young adults, we have the potential to be a force for positive change, and I believe we have the power to make an impact regarding this issue.

Works Cited

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