The U.S. Is Running Short on Family Physicians. The Pay Gap Between Cognitive and Procedural Medicine Is a Major Reason Why.

Analysis by DPC Insider
#physician shortage#primary care workforce#payment reform#rural health#DPC growth#practice model
Sources: America's Least-Discussed Physician Shortage Is Getting Worse — Forbes, August 4, 2026 · Hint Health Releases 2026 Direct Primary Care Trends Report: Data Shows DPC Has Moved From Niche Alternative to National Healthcare Infrastructure — PR Newswire, April 23, 2026 · Hint Health Releases New Benchmark Report Measuring the Patient Experience in Direct Primary Care — PR Newswire, February 2026 · New AAMC Report Shows Continuing Projected Physician Shortage — AAMC · 2024 Direct Primary Care Data Brief — American Academy of Family Physicians · MedPAC Recommends Per-Beneficiary Payment for Primary Care — MedPAC · RBRVS Overview — American Medical Association

The United States will face a shortage of up to 86,000 physicians by 2036, according to AAMC projections. The shortfall cuts across multiple specialty areas. What most headlines miss is the shortage in cognitive medicine: family medicine, geriatrics and sleep medicine.

A Forbes analysis published August 4 named the driver: a reimbursement system still weighted toward procedures. A family doctor is paid for time spent talking and coordinating care; a proceduralist is paid for the procedure. That payment gap is built into how Medicare values physician work. Medical students graduating with six-figure debt follow those incentives and choose procedural specialties in numbers that primary care cannot match.

The access problem shows up in geography. More than 40 million rural Americans live in federally designated primary care shortage zones, according to the Forbes analysis. Forbes reports that rural primary care is projected to meet roughly 68 percent of demand by 2037.

The Payment System Behind the Shortage

The Resource-Based Relative Value Scale, which Medicare uses to set physician payment rates, factors in physician time and skill, practice costs, and malpractice expenses to arrive at each service’s relative value. MedPAC, the independent congressional advisory body on Medicare, has documented that the fee schedule undervalues primary care relative to specialty care and has recommended rebalancing it.

Two forces build the shortage: a pay signal that steers graduates toward procedural specialties, and burnout that pushes practicing primary care physicians out of practice or into reduced hours ahead of schedule.

What Removing Insurance Changes

Direct primary care operates outside that system. A DPC practice charges a monthly membership fee and delivers primary care without per-visit insurance billing. The physician sets the fee.

That change alters the pay structure at the practice level. A DPC physician prices an hour of cognitive medicine without reference to Medicare’s payment schedule. The fee reflects what the physician and patient agree on, not what a coding system sets.

The Hint Health 2026 Direct Primary Care Trends Report, drawing on data from more than 2,700 DPC clinicians and 1.4 million members, found that DPC clinicians reported a 48 percent reduction in burnout. Average DPC panel size runs around 500 patients, against roughly 2,000 in conventional primary care. DPC membership has grown 837 percent since 2017. According to Hint Health’s platform data, its network reaches more than 7,200 employers.

The AAFP’s 2024 DPC data brief found that 94 percent of DPC physicians expressed satisfaction with their overall practice, against 57 percent of non-DPC physicians. Forty-nine percent said they experienced no burnout, compared with 14 percent of their non-DPC counterparts.

Those numbers describe a practice setting with a different relationship to the administrative and financial pressures of conventional primary care. The physician count stays the same.

What DPC Doesn’t Address

A physician switching to DPC doesn’t add to the physician supply. They leave one setting and enter another, typically serving a smaller panel. If 10,000 physicians shifted to DPC tomorrow, the country would have the same number of physicians, each serving fewer patients on average.

Where DPC contributes to the shortage is on the retention side. A physician who stays in practice for another decade produces more cumulative primary care than one who burns out and leaves at year twelve. The Hint Health and AAFP data describe a practice setting with significantly higher satisfaction and lower burnout rates. That matters. It’s also a narrower claim than saying DPC fixes the primary care supply problem.

The structural issue (the pay signal that steers medical students away from family medicine during training) hasn’t changed. DPC offers an exit from the downstream effects of that signal for individual physicians. It doesn’t reach into residency match patterns or the debt environment that shapes where residents apply.

What This Means

AAMC’s projection (up to 86,000 short by 2036) is wide enough to accommodate a range of policy responses, or none at all. The rural access gap points to where the shortage will land hardest.

DPC is growing, with practices now operating across 49 states and membership numbers that have risen sharply since 2017. Whether it grows fast enough, and reaches the specific communities most affected, is a question the projections don’t answer.

The pay structure that created the shortage is intact. DPC lets some physicians work around it. The physicians who’ve made that move are, on the evidence, practicing with significantly higher satisfaction. But the pipeline producing family medicine physicians is still running through a training and debt environment shaped by the same reimbursement system that makes the specialty harder to choose.

That’s the harder problem. And it hasn’t moved.