V. Research: The lack of research dollars to study the practice of primary care is limiting evidence-based improvements in care

Despite the dire picture much of these data paint for the state of primary care, there are bright spots where primary care is flourishing. Yet more research is needed to discover, analyze, and scale innovations that are moving primary care forward. As the primary care landscape evolves, with hospitals and for-profit entities increasingly acquiring primary care practices, it is crucial to examine the effects of these changes on both clinicians and their patients. Currently, less than 1% (0.34%) of all federal research dollars are spent on investigating primary care despite its status as the backbone of our health care system (Figure 14).

Figure 14. Federal Research Funding for Primary Care Grows Marginally but Remains Below 1% of Total Budget (2017—2023)

Data Sources: NIH RePORTER, 2017—2023.

Notes: Federal investment includes spending from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and the Food and Drug Administration. Funding given to family medicine departments was used as a proxy for funding to primary care.

Since the last edition of this report, there has been an increase in federal funding for primary care research. Specifically, the National Institutes of Health (NIH) made a $30 million investment in primary care research networks, suggesting that federal agencies are recognizing the importance of studying what is happening in primary care practices.101 While these dollars are being spent on how primary care clinicians can impact patients with certain disease processes and not necessarily going toward understanding models of primary care that may benefit the entire population, the investment is a step in the right direction and underscores the value of primary care for the health of the population. 

Progress on Policy Solutions: Accountability

ACTION 5.1: The HHS secretary should establish a Secretary’s Council on Primary Care to coordinate primary care policy, ensure adequate budgetary resources for such work, report to Congress and the public on progress, and hear guidance and recommendations from a Primary Care Advisory Committee that represents key primary care stakeholders. 

• No movement on creation of Secretary’s Council. In 2024, however, NASEM established a Standing Committee on Primary Care to work in the areas identified in the 2021 NASEM primary care report and serve as a point of contact and accountability with the US Department of Health and Human Services.

ACTION 5.2: HHS should form an Office of Primary Care Research at NIH and prioritize funding of primary care research at AHRQ. 

• No movement on an office of Primary Care Research at NIH. 
• NIH has taken steps toward increasing funding for primary care research with a $30 million investment in studies that are conducted within rural practice-based research networks. 
• AHRQ’s Healthcare Extension Service is funding states to accelerate the dissemination and implementation of patient-centered outcomes research with the goal of significantly reducing the time span between evidence generation and its use in health care delivery, including primary care.

ACTION 5.3: Primary care professional societies, consumer groups, and philanthropies should assemble, regularly compile, and disseminate a “High-quality primary care implementation scorecard” to improve accountability and implementation. 

• The Milbank Memorial Fund, in conjunction with the Physicians Foundation and the Robert Graham Center for Policy Studies in Primary Care, have developed and published this national primary care scorecard and dashboard with state-level data for the past three years. 
• The federal government has proposed measures for creation of a federal dashboard on primary care. 
• Organizations in states such as Massachusetts, Virginia, and New York have created state dashboards that track primary care workforce, quality, and related issues at the state level. 

Conclusion

Over the past decade, the neglect of primary care in the United States has contributed to a fragmented health care system that often fails to meet the needs of patients. This year’s report highlights the ways in which the lack of appropriate investment in primary care underpins all the worrisome findings the Scorecard has highlighted over the past three years. This year, we found:

• Declining investment and the fee-for-service payment model are hindering primary care clinicians’ ability to meet patients’ growing needs.
• Insufficient funding is diminishing the primary care workforce and access to care.
• Misdirected graduate medical education funding is failing to produce enough new primary care physicians, exacerbating patient access issues.
• The lack of investment in technologies that benefit primary care has resulted in burdensome systems that limit clinicians’ time, thereby reducing patient access to care.
• The lack of research dollars to study the practice of primary care is limiting evidence-based improvements in care for patients.

This year’s report highlights examples that demonstrate the benefits of significant and smart investments in primary care. From implementing AI scribes to scaling value-based payment models in Medicaid, these investments have the potential to make a significant difference in quality of life for primary care clinicians and the quality of care provided for patients. The report also looks at what it takes for medical schools to draw more medical residents to primary care, and how one state is working toward better aligning Medicaid GME dollars with residents’ population health needs, including their need for primary care.

These successes, however, often occur despite the larger policy environment, not because of it. While the report found that some policy changes are underway in all areas studied — payment models, workforce, training, technology, and research — it remains to be seen whether these changes will make an appreciable difference in the primary care experience for clinicians and their patients. Without decisive action and substantial investment in primary care, we are perpetuating a cycle of neglect that undermines the very foundation of our health care system and endangers the health of our communities. 

Acknowledgements

The authors are deeply grateful to the study’s subject matter experts, members of the Scorecard national advisory committee, and members of the American Academy of Family Physicians, all of whom generously shared their time, diverse perspectives, and valuable insights into the national Scorecard measures, operationalization, and computation. They also thank Milbank Memorial Fund Communications Director Christine Haran for her editorial support.

• Scorecard advisory committee members:
• Bijal Balasubramanian
• Rebecca Etz
• Margaret Flinter
• Ripley Hollister
• Corinne Lewis
• Sunita Mutha
• Barbra Rabson
• Diane Rittenhouse
• Michelle Roett
• Eric Schneider
• Judith Steinberg
• Efrain Talamantes

Our acknowledgment of these leaders’ contributions does not imply that any of these individuals endorse the contents or conclusions of this report. 

Notes

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