Addressing the Primary Care Shortage with AAFP’s Shawn Martin

Summary

Becker’s Healthcare Podcast: Addressing the Primary Care Shortage with AAFP’s Shawn Martin

Release Date: August 5, 2025

In this enlightening episode of the Becker’s Healthcare Podcast, host Scott Becker engages in a critical conversation with Shawn Martin, CEO of the American Academy of Family Physicians (AAFP). The discussion centers on the alarming shortage of primary care physicians in the United States, exploring its causes, implications, and potential solutions to ensure the sustainability of primary healthcare.

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1. Introduction to the AAFP and Its Role in Primary Care

Scott Becker opens the episode by introducing Shawn Martin, emphasizing the crucial role of family physicians in the American healthcare system. Martin provides an overview of the AAFP, highlighting its representation of approximately 130,000 family physicians and learners across the United States.

Shawn Martin [00:37]: "We are a big organization, both in size and in scale. We have a family physician practicing in about 95% of U.S. counties, and on any given year, about 200 million unique individual visits are made to a family physician somewhere in the country."

2. The Current State of the Primary Care Shortage

The conversation delves into the stark reality of the primary care shortage, with Martin presenting sobering statistics.

Shawn Martin [02:49]: "Our primary care physicians to population is at historic lows. It's at very dangerous lows as compared to other countries around the world that have, you know, what we would consider to be comparable or highly functioning healthcare systems."

Martin cites that as of 2023, there are about 67 primary care physicians per 100,000 people in the U.S., a significant decrease from previous years and notably lower than countries like Canada, which boasts approximately 116 primary care physicians per 100,000 people.

3. The Team-Based Approach to Primary Care

Becker and Martin discuss the evolving landscape of primary care, emphasizing the importance of a team-based approach that includes nurse practitioners (NPs) and physician assistants (PAs) alongside family physicians.

Shawn Martin [05:27]: "Primary care is a team sport. There are unique roles that family physicians and general internists and pediatricians play that are unique to their skills and training. But NPs and PAs are an important part of that team."

However, even when including NPs and PAs, the total number of primary care clinicians remains insufficient, underscoring structural issues in the U.S. primary care infrastructure and financing.

4. Graduate Rates and Workforce Projections

The discussion shifts to the pipeline of new primary care physicians and the gap between supply and demand. Martin outlines the current and projected needs for primary care physicians.

Shawn Martin [09:57]: "We need somewhere between about 45 and 80,000 primary care physicians over the course of the next decade."

With approximately 450,000 full-time primary care physicians currently in the U.S. and around 5,000 new family physicians graduating annually, there is a significant shortfall projected to worsen without substantial intervention.

5. Alternative Models: Direct Primary Care vs. Concierge Medicine

A substantial portion of the conversation addresses emerging models in primary care practice, particularly Direct Primary Care (DPC) and concierge medicine.

Understanding Direct Primary Care (DPC):

Shawn Martin [16:00]: "Direct primary care is a direct financial engagement between an individual patient or family and a primary care physician through what I will refer to as a membership or subscription model."

In this model, patients pay a monthly or annual fee for comprehensive primary care services without involving insurance companies. This arrangement aims to reduce administrative burdens and foster a closer physician-patient relationship.

Distinguishing Concierge Medicine:

Shawn Martin [17:16]: "Concierge tends to be a financial arrangement that provides some access and asynchronous connectivity with the patient, but the financial arrangement is still largely insurance-based."

Unlike DPC, concierge medicine involves an access fee while still billing insurance for primary care services. This model often results in physicians managing smaller patient panels, thereby enhancing access and personalized care.

6. Innovations and Legislative Support

Martin highlights the growing optimism around DPC, driven by legislative changes and shifts in the healthcare financing landscape. He notes that provisions in recent legislation have made DPC more attractive to both patients and physicians by simplifying financial relationships and reducing administrative complexities.

Shawn Martin [15:14]: "Direct primary care is really creating that opportunity for physicians to spend more time with patients and less time on paperwork."

7. Addressing the Administrative Burden

The administrative burden in primary care is identified as a significant barrier to physician satisfaction and efficiency. Martin references a Health Affairs study indicating that primary care physicians spend a considerable portion of their time on administrative tasks rather than patient care.

Shawn Martin [15:14]: "Most primary care physicians will spend 30 to 40% of a patient visit actually engaged with the patient and they will spend 40 to 50% of that visit engaged with some administrative function."

DPC models, by minimizing insurance-related paperwork, offer a potential solution to this pervasive issue.

8. Call to Action and Resources

In closing, Martin encourages listeners to engage with the AAFP to support and enhance the primary care workforce. He provides resources for further information and emphasizes the importance of community and legislative support in addressing the primary care shortage.

Shawn Martin [18:25]: "AFP is a wonderful organization. I'm really proud of the incredible work our members are doing every day across the country and really looking forward to building a better workflow and a better opportunity for them to take care of people and communities."

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Conclusion

This episode of the Becker’s Healthcare Podcast offers a comprehensive exploration of the primary care shortage in the United States, underscoring the urgent need for systemic changes in healthcare financing and practice models. Shawn Martin’s insights into the challenges and innovative solutions present a roadmap for sustaining and enhancing primary care delivery in the nation.

For more information about the American Academy of Family Physicians and to support primary care initiatives, listeners are encouraged to visit familydoctor.org or connect with Shawn Martin on social media platforms.

Transcript

[A]

This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by Shawn Martin, and Sean is the leader of the American association of Family Physicians. There's been so much discussion over the last couple years about the incredible shortage of family physicians, of internists, of general practitioners, that we were so thrilled to get the chance to visit with Sean and get his thoughts on and where we're going in terms of primary care as a nation and more. Sean, can you take a moment and introduce yourself and tell us about the association too, if you don't mind?

[B]

Great. Well, Scott, thank you so much for the invitation to join you and just appreciate the opportunity to engage with you and huge fan of your work and your leadership in the healthcare space. But again, as you said, my name is Sean Martin. I'm the CEO of the American Academy of Family Physicians. The AAFP represents about 130,000 family physicians and learners in training across the United States. We are a big organization, both in size and in scale. We have a family physician practicing in about 95% of U.S. counties, and on any given year, about 200 million unique individual visits are made to a family physician somewhere in the country. So we are at the. We always refer to it as kind of the main street of healthcare delivery. We are embedded in communities and our members are out there doing a variety of work, really, in service to the promotion of health and disease mitigation with individuals of all ages and all types of communities, from the most urban to the most rural and even frontier communities.

[A]

Thank you. And I happen to be a huge fan of my primary care physician who I've been with forever. Take a moment. When I look at things more and more, you're seeing a nurse practitioner, you're seeing a pa. The primary care steps in. At some point, more and more primary care physicians are going concierge. The stats, the calculators, the people that estimate these things give all kinds of difference of numbers of shortages of primary care physicians. I've heard the number 200,000 in our country produces 25,000 doctors a year. Of that, I assume 8,000 or so are primary care doctors. You have a better number than I do. It just seems like we're in an insurmountable hole in terms of true primary care being done truly by primary care physicians. I don't like that that's the case, but I'd love to hear your thoughts on that and where we're going as a nation and where we're at in primary care.

[B]

Yeah, well, it's a Great observation. And I think the numbers do point in a direction that should concern all of us. I mean, our primary care physicians to population is at historic lows. It's at very dangerous lows as compared to other countries around the world that have, you know, what we would consider to be comparable or highly functioning healthcare Systems. As of 2023, there were about 67 primary care physicians per 100,000 people. You compare that, that's a 2 percentage drop from two years previously. And it compares to about 116 per 100,000 in a country like Canada. So you bring in MPs and PAs. And we believe here at the AAFP that primary care is a team sport. There are unique roles that family physicians and general internists and pediatricians play that are unique to their skills and training. But MPs and PAs are an important part of that team. But even if you add in MPs and PAs, Scott, we're still only at about 102 primary care clinicians per 100,000 population. There is something wrong with the primary care infrastructure and the primary care finance function in the United States that is unique to us. That's not found in other healthcare systems around the world. And I would suggest to you that it's the way we finance it, the way we think about benefit design, and certainly the complexity of the administrative state that plays out at a much larger scale in primary care than it may in other disciplines of medicine.

[A]

So how do we have an impact on that number? Or we talk about it being a team sport, clearly, when we're in that direction, are we moving in direction? The analog I see that I'm scared of is, and I love the dental hygienist. You go to the dentist for your regular appointment. You used to spend a good deal of time with the dentist. Now you see the dental hygienist, the dentist steps in for two to five minutes at most. Is my experience. You know, sort of takes a look at a couple things the dental hygienist has said to them, takes a quick look and you're done.

[B]

Right?

[A]

You know, I know like for. I recently had an orthopedic visit not that long ago. Spent the great majority of the time with the PA team. The PA team was fantastic. So I don't feel like the experience was lost at all. But it's a different experience than it used to be. How much is the primary care experience moving towards that experience that you have with the dentist and the dental hygienist?

[B]

Well, I think in some places, you know, the, you know, the team based approach to primary care is, is the right answer. And I don't know that it always looks like the dental experience as much as it may look like an acuity experience. So the different levels of need based upon the patient's presentation may dictate within a primary care team when they see a family physician or when they see a nurse practitioner, or when they see a clinical pharmacist, et cetera. I think the complexity in really pursuing that type of an approach is it's not really supported by our payment model, it's not really supported by the benefit designs of health insurance, both public and private. But I think, you know, we have, we're a aging and sick nation. I mean, you know the statistics very well. I mean, the prevalence of chronic disease, people are living more years with chronic disease. We need primary care physicians because we have high acuity patients that have high needs that can be met best by primary care physicians. But there are other portions of the system that certainly a team based approach to primary care is going to best serve that patient in that community. And I think it's building. It's an and not an or for me. How do we make sure everybody is contributing to the promotion of health and the mitigation of disease in the primary care function? But we as individuals should want primary care physicians because there is a prevalence of disease that really needs them.

[A]

And we couldn't agree more. There are so many things that PA or nurse practitioner knows and so many things they don't know and they don't know if they know them or not. And hopefully a primary care physician is that much more deeply educated and has that much more experience and can help see the holistic patient maybe in a different way that every nurse practitioner and PA cannot. And again, PAs and practitioners are brought to genome. Some of them are just fantastic, some of them are not. But that's the case with doctors as well. What are the stats on how many primary care doctors we graduate a year coming out of residencies? Do you have a rough number on what that looks like? And how many, like how many primary care doctors do you count in the country when you look at stats and you think about how many we need, do you have some of those stats, Shawn, and how do you think about those?

[B]

Yeah, so I mean, we think about it, you know, comprehensively over time. So it's difficult to, you know, do. Let me start on the physician side. So this is a biased statement and I say it up front, but every family physician you produce is going to go into Primary care. I mean, most of our members are, you know, greater than 80% of them are going to be in some type of clinical based, community based continuity primary care practice. So they're going to be in primary care most of their career. When you look at our primary care colleagues on internal medicine and pediatrics, more and more of those individuals are specializing, but still a number of them are going to go into general community based continuity primary care. Where we're kind of alarmed is the dramatic drop in the number of nurse practitioners and physician assistants that are actually going into primary care. And you know, our latest statistics, which was published in the, in what's called the primary care scorecard, only about 30% of nurse practitioners and about 23% of PAs are actually going in to primary care practices. So, you know, at the top of our conversation, I pointed to the fact that, you know, a lot of the numbers we look at suggest that the primary care phase function needs to be repaired. Because you just see these trend lines where everybody is disenfranchised by the function of primary care and they're not moving into those practice opportunities. And there's a lot of ways to fix that. There's a lot of ways that we're promoting to fix that. There's some innovation taking to fix that. But I think as a country we should be deeply worried about that.

[A]

Yes, but I don't know if I. Do you have a sense of how many doctors?

[B]

Oh yeah, yeah, yeah. So we, you know, we need somewhere between about 45 and 80,000 primary care physicians, you know, over the course of the next decade. Now, you know, these workforce projections become, you know, complicated because it assumes modern capacity. So like the, you know, each new physician will essentially see the same number of patients as the physicians that are in today. And I think we can expand capacity of the existing workforce with some innovative approaches to primary care. But there's roughly about 450 to 550,000 full time primary care physicians in the United States today, give or take.

[A]

Give me that number again.

[B]

I think it's about 450,000.

[A]

And how many are produced a year? How many get through a residency? You're about.

[B]

Yeah. So on family medicine, we produce just a little north of 5,000 new family physicians a year. So our residency matched last year. We filled about 5,300 positions. So when we're graduating, about that number every year. So a little more than 5,000. I don't have internal medicines numbers. It's much larger of the total number of internal medicine residents. But, you know, only about 40% of them go into primary care, as you know, after their fellowship windows. So.

[A]

So it's probably something like. So if 400,000. There's 400 something thousand plus primary care physicians in the U.S. something like that. 400,000 plus we produce another between family physicians and internal medicine physicians. Maybe 12,000 a year.

[B]

If you had any pediatrics. I mean, I think you probably get to about 12,000 a year. Yeah.

[A]

Okay. Okay. And so of about 24,000 a year produced, about 12,000 are somewhere primary care, family medicine, internal medicine, pediatrics. We need to add 45 to 80,000 over the next decade. That's probably at the most minimum, assuming that we keep up on MPs and PAs and are highly qualified. Got it. Yeah. It just, it does seem daunting to me. And I recently, and I. You saw this tweet I'd had, I think, where I went to reschedule my primary care visit. And his next available appointment was next April. And again, and I know I could work the system, whatever, and get in earlier, but not everybody can. Not everybody can work the system, get in earlier. I think I could work the system getting an earlier. But it just points to me that, you know, it's not so much that the annual physical is everything, but it was just. It was just one of those signals to me that, you know, one of those, you know, Houston, we have a problem signals if the next available appointment. I almost thought they had the schedule wrong. So I called the office, said, no, no, no, it's next April 2026. Yeah, it. And where are the primary care physicians, the family physicians? How many of those are moving towards concierge versus traditional open practice? What do you see out there, the different sort of sites that physicians of practice get to?

[B]

Yeah, what a great question. So I think for us, you know, a large number of our members are in what we would, you know, characterize, I think, from a historical perspective, Scott, of just, you know, a traditional independent, you know, small to medium sized group practice. And that practice may be owned, you know, by the physicians themselves. It may be owned by a hospital. It may be owned by some type of, you know, private equity or other, you know, capital bearing group. There's a lot of physicians that work for community health centers. A large number of family physicians will be in the community health center and rural health clinic space. And then, you know, we have a smattering of academic physicians that are teaching in residency programs and things like that. So where we see the biggest trends in our membership. So over the last decade, We've gone from about 1% to today we're probably somewhere around 10 or 11% is in a practice model called direct primary care. So not concierge, but a dedicated primary care practice that creates the financial relationship between the practice and the physician themselves with the patient or the patient's employers. It's really independent of broader insurance design. It's a membership based or subscription based approach to primary care. We see a lot of optimism both on the patient side and the physician side for this model. And you know, thanks to some provisions that were included in the one big beautiful bill, we're seeing a lot of enthusiasm on the employer side because of some changes in the tax code. And I think one of the reasons you see DPC really taking hold is it gets out of another issue that I think is really damaging to primary care, which is the administrative complexity of modern day practice. Health Affairs a couple years ago published an article that said, you know, most primary care physicians will spend 30 to 40% of a patient visit actually engaged with the patient and they will spend 40 to 50% of that visit engaged with some administrative function. And you and I don't want to do that much paperwork in our jobs. And physicians so certainly don't want to do that much paperwork. They really want to spend their time with the person in the room with them. And I think direct primary care is really creating that opportunity for them to do that.

[A]

And Sean, help me out on this in terms of direct primary care versus concierge service, because I've seen over, you know, suddenly the term DPC is popping up a lot, you know, and is that like the one medicals in the world? What is direct? What does DPC actually, What does that actually mean? What is that? Give me an example. Because when I first think of direct primary care dpc, my mind goes to this is a different kind of concierge, but you're saying something different. Explain to me DPC versus concierge. I don't know that my certainly understanding of it all is not kept up and I assume some of our audiences has not too.

[B]

If you don't mind, I'd be happy to. So this is Sean's definition. You may get some feedback of difference of opinions, but I view direct primary care is a direct financial engagement between an individual patient or family and a primary care physician through what I will refer to as a membership or subscription model. So there is a price point per month for comprehensive and continuous all inclusive primary care that is provided by the physician for a particular price point on a monthly or annual basis. And you know, those price points range from, you know, 60 or $70 per month to, you know, 150, 200, $250 per month for patients. They do not engage with the insurance system so the themselves will not bill insurance. So concierge tends to be a 5 a financial arrangement that provides some access and asynchronous connectivity with the patient, for the patient, with the physician. But the financial arrangement is still largely insurance based. So the physician is still billing insurance for primary care. Those.

[A]

Right. As I understand it, Sean, this is extremely helpful. If you're buying direct primary care, you're actually buying a bundle of primary care services and those services aren't separately building the insurance company. Obviously if you're outside that bundle of whatever that Is, test hospitalizations, etc. Being billed to the insurance company. With concierge you're paying an access fee. The physician is still billing insurance. But the promise you're getting in concierge is the physician is only going to take so big a panel so you're going to have better access than the normal situation. It reminds you somewhat buying a club membership or an NFL personal seat license. You still have to pay for the tickets, but you've got the access that somebody else would not have messaged you. DPC and concierge and very helpful because I've never had it broken down. So thank you Sean. Just, just, just last question. You run an incredible organization. How can people learn more about the American association of Family Physicians? Tell us how they can learn more about the association and more about you.

[B]

Sure. So you can learn more about the [e-mail] if you want to engage with our consumer or patient facing content that is located at a content site called familydoctor.org I am on all social media channels, largely at rshawnm on various platforms and of course I do a lot of my thought leadership on LinkedIn like you do and others. But AFP is a wonderful organization. I'm really proud of the incredible work our members are doing every day across the country and really looking forward to building a better, you know, workflow and a better opportunity for them to take care of people and communities.

[A]

Sean, it is literally fantastic to speak to you. We'd love to have you back whenever you'd like to to give us an update on sort of primary care nation and where we're at in primary care. This has been extremely informative. We're the biggest fan of our nation's primary care physicians, our family physicians. We just want there to be more of them. Sean, thank you so much for joining us today.

[B]

Thanks so much, Scott.