Graham Center Policy One-Pagers Provide Perspectives on the State of Primary Care


Am Fam Physician. 2021 Aug ;104(2):124-125.

Related Graham Center Policy One-Pager: State-Level Variation in Primary Care Physician Density

For more than two decades, American Family Physician (AFP) has published a continuing series of policy briefs from the American Academy of Family Physicians' Robert Graham Center.1 Based in Washington, D.C., the Graham Center creates and curates evidence to inform policies that support primary care and family medicine. Most of the work of the Graham Center is derived from questions coming directly from practicing physicians.

Previous Graham Center Policy One-Pagers published in AFP have provided timely perspectives on a range of topics, such as family physicians' contributions to the care of infants, children, and older adults24; attributes that patients most value in their family physicians5; effects of income disparities on medical student specialty choice6; and the underutilization of family physicians in addressing the opioid epidemic.7

In 2020, the Graham Center, in collaboration with IBM Watson Health and the American Board of Family Medicine, produced a chartbook of statistics on the current state of primary care in the United States.8 This issue of AFP features a Graham Center Policy One-Pager derived from this chartbook, demonstrating a wide variation in the ratio of primary care physicians to population by state, with the two highest states (Maine and Vermont) having more than twice the ratio of the lowest (Mississippi).9

Subsequent issues of AFP will feature additional analyses of primary care physicians' employment status and scope of practice. These brief reports aim to inform AFP's readers about the demographics and practice circumstances of U.S. family physicians and primary care clinicians, as well as provide evidence from research to support advocacy for primary care and population health.

Primary care is at a critical juncture. A consensus report from the National Academies of Sciences, Engineering, and Medicine recently affirmed the foundational role of primary care in optimizing individual and population health and called on state and national policy makers to make high-quality primary care “a common good that is accessible to everyone.”10,11 A recent editorial in AFP described the collaboration of several primary care physician societies and boards, including the American Academy of Family Physicians, to create a new health care payment paradigm with the principles of primary care serving as the backbone.12 Although the COVID-19 pandemic has demonstrated the impressive versatility of family medicine to meet changing health system needs, it has also dangerously stretched practice finances and challenged the resilience of many primary care physicians, with 71% reporting all-time high levels of burn-out or mental exhaustion.13

The primary care chartbook is just one of many resources that remind us of the central role family physicians have in helping our communities thrive. The Graham Center will continue to research the myriad important issues faced in family medicine: payment, workforce, education and training, burnout, and joy of practice. The editors of AFP hope to hear from you. Please share your successes and questions by emailing afpjournal@aafp.org.

Editor's Note: Dr. Lin is deputy editor of AFP.

Author disclosure: No relevant financial affiliations.

Address correspondence to Kenneth W. Lin, MD, MPH, at kenneth.lin@georgetown.edu. Reprints are not available from the authors.


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1. Wright J. Introducing AAFP Policy Center One-Pagers. Am Fam Physician. 2000;62(1):19. Accessed May 26, 2021. https://www.aafp.org/afp/2000/0701/p19.html...

2. Mold JW, Fryer GE, Phillips RL Jr, et al. Family physicians are the main source of primary health care for the Medicare population. Am Fam Physician. 2002;66(11):2032. Accessed May 26, 2021. https://www.aafp.org/afp/2002/1201/p2032.html

3. Mold JW, Fryer GE, Phillips RL Jr, et al. Family physicians increase provision of well-infant care despite decline in prenatal services [published correction appears in Am Fam Physician. 2003;68(6):1119]. Am Fam Physician. 2003;67(1):17. Accessed May 26, 2021. https://www.aafp.org/afp/2003/0101/p17.html

4. Robert Graham Center. The diminishing role of FPs in caring for children. Am Fam Physician. 2006;73(9):1518. Accessed May 26, 2021. https://www.aafp.org/afp/2006/0501/p1518.html

5. Keister MCS, Green LA, Kahn NB, et al. What people want from their family physician. Am Fam Physician. 2004;69(10):2310. Accessed May 26, 2021. https://www.aafp.org/afp/2004/0515/p2310.html

6. Wilder V, Dodoo MS, Phillips RL Jr, et al. Income disparities shape medical student specialty choice. Am Fam Physician. 2010;82(6):601. Accessed May 26, 2021. https://www.aafp.org/afp/2010/0915/p601.html

7. Crothers J, Petterson S, Bazemore A, et al. Family medicine: an underutilized resource in addressing the opioid epidemic? Am Fam Physician. 2016;94(5):350. Accessed May 26, 2021. https://www.aafp.org/afp/2016/0901/p350.html

8. Willis J, Antono B, Bazemore A, et al. The state of primary care in the United States: a chartbook of facts and statistics. February 2021. Accessed June 29, 2021. https://www.graham-center.org/content/dam/rgc/documents/publications-reports/reports/PrimaryCareChartbook2021.pdf

9. Merrit K, Jabbarpour Y, Petterson S, et al. State level variation in primary care physician density. Am Fam Physician. 2021;104(2):133–134. Accessed August 12, 2021. https://www.aafp.org/afp/2021/0800/p133.html

10. National Academies of Sciences, Engineering, and Medicine. Implementing high-quality primary care: rebuilding the foundation of health care. 2021. Accessed May 24, 2021. https://www.nationalacademies.org/our-work/implementing-high-quality-primary-care

11. Phillips RL Jr, McCauley LA, Koller CF. Implementing high-quality primary care: a report from the National Academies of Sciences, Engineering, and Medicine. JAMA. 2021;325(24):2437–2438.

12. Stewart AD. Prioritizing primary care can save the U.S. health care system. Am Fam Physician. 2021;104(1):14–15. Accessed July 15, 2021. https://www.aafp.org/afp/2021/0700/p14.html

13. The Larry A. Green Center. Primary Care Collaborative. Quick COVID-19 primary care survey series 28 fielded April 9–13, 2021. Accessed May 24, 2021. https://www.pcpcc.org/sites/default/files/news_files/C19%20Series%2028%20National%20Executive%20Summary.pdf



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