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Am Fam Physician. 2003;68(8):1483

See editorial on page 1494.

Growth in the primary care physician workforce (physicians per capita) in the United States has trailed the growth of the specialist physician population in recent years. This has occurred despite calls during the same period for increased production of primary care physicians and educational reforms focusing on primary care.

Physicians' offices remain the most likely place Americans receive formal health care in the United States. The number of physicians per capita who classified themselves as “office-based” increased by 53 percent between 1980 and 1999, resulting in 428,923 office-based physicians or 1.57 per 1,000 people.

As shown below, only modest success was achieved between 1980 and 1999 in increasing the number of primary care physicians per capita (family physicians +0.3 percent, general internists +8.0 percent, and general pediatricians +7.5 percent) while the production of other physician specialists was much greater (+41.0 percent). Specialists accounted for more than three fourths of the growth in the physician (per capita) workforce from 1980 to 1999, despite concerted, widely publicized policy and funding efforts to increase the number of primary care physicians.

There was no great resurgence of primary care physicians in the United States at the end of the 20th century. Instead, the period from 1980 through 1999 continued a relentless, relatively rapid expansion of the subspecialized physician workforce. This is not good news for the development of a balanced physician workforce thought to be necessary for effective, sustainable healthcare. Fresh strategies are needed to develop and sustain primary care physicians.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Graham Center Policy One-Pagers published in AFP is available at One-Pagers are also available at

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