Where Americans Get Care in 2026—And Why It Matters
I’m a pretty healthy person, and I try to see my primary care provider once a year. What’s wild is that I have to schedule next year’s annual visit as I’m walking out of this year’s appointment. I have access to great healthcare, and still have to book that far out. If I need a sooner visit for something urgent, good luck to me.
Over the past week, a few things have stood out to me:
A new CDC study showing where U.S. adults are getting their healthcare.
A LinkedIn post by Howard Wilson, MD, showing that the number of urgent care centers in the U.S. has surpassed the per-capita density of primary care physicians.
At the same time, I’ve been working with Lumeris, which is using AI (via their agentic AI tool called, Tom) to help expand primary care panels.
It’s all coalescing at once, and I think it’s worth talking about.
In this article, I highlight the latest CDC healthcare data, map primary care trends, and explain why we need to increase both physician supply and panel capacity at the same time.
The Deets: Where Do People Get Their Healthcare?
Researchers at the CDC released a report analyzing sources of usual health care among adults age 18 and older, by sex and age group, for 2024. I encourage you to read it yourself, but I’ll highlight the results I found most interesting.
First, 90% of adults reported having a usual source of care, meaning a place they can turn to when they get sick or need care. That’s reassuring. Still, 10% didn’t have a “usual place” to go if they became ill, so I’m assuming their default is the emergency department (though they may not have reported it).
Second, there was a clear age disparity in who uses a doctor’s office or health center for usual care. Among 18–34 year olds, only 68% reported a doctor’s office or health center as their usual source of care, compared with 89% of adults 65 and older. This increased with age.
Source: CDC
On the flip side, this pattern was reversed for adults who reported an urgent care center or a clinic in a drug store (e.g. CVS Health) or grocery store (e.g. ACME) as their usual source of care, starting at 12.2% for 18–34 year olds and decreasing to 4% for adults 65 and older.
Source: CDC
As an extension to the above, Dr. Howard Wilson, posted the below, showing how urgent care centers have nearly tripled since 2010 while PCP density dropped 22%.
Broader Primary Care Trends
There are several key trends in primary care that I want to quickly mention, which may help explain the above:
Persistent and Worsening Workforce Shortages: The U.S. faces a projected shortfall of up to 70,610 primary care physicians by 2038, compounded by record burnout rates (62.8% of physicians in 2021) and an aging physician workforce nearing retirement.
Maldistribution: Urban-Rural Divide: Rural areas average just 5 primary care physicians per 10,000 people compared to 8 primary care physicians 10,000 people in urban areas.
Decline in Per-Capita Primary Care Visits: Primary care visits among commercially insured patients fell 7% from 2018 to 2024, and for the first time, behavioral health visits surpassed primary care visits in 2024 (66.4M vs. 62.8M).
Shrinking Panel Sizes: Traditional PCP panels range from 1,500–2,500 patients, but there's a growing movement toward smaller panels in direct primary care and concierge models to combat burnout, despite the access trade-offs.
Rapid Expansion of NPs and PAs: Ambulatory care visits (not primary care visits, specifically) to NPs, PAs, and RNs nearly doubled (+98%) from 2010 to 2021, driven by expanded scope-of-practice laws, lower training costs, and rising physician shortages.
Shift Toward Employment and Consolidation: Nearly 80% of U.S. physicians are now employed by or affiliated with hospital systems or other corporate entity (e.g. retailer, private equity), largely driven by reimbursement pressures and administrative burden. See my latest article on this here, and my latest class on physician consolidation here.
Evolving Care Models (e.g., Direct Primary Care): The number of concierge and direct primary care practices grew 83% between 2018 and 2023. Read my latest, The Future of Healthcare: Why Subscription Medicine Is Taking Over.
So, primary care access is shifting fast, and whether we shore up the workforce or scale new models, the next few years will define how—and where—patients get care. On to my next section….
Dashevsky's Dissection
I'm biased, of course, but as both a physician who practices primary care and a patient who needs primary care, I see firsthand how imperative it is. The population is aging, we're living longer, and we'll be living with more chronic disease, which means someone needs to help manage it all—and that someone is the primary care physician. Urgent care, at the end of the day, cannot do that and shouldn't try—unless it is staffed by physicians trained in primary care or internal medicine. It shouldn't be another specialty (e.g. emergency medicine) trying to fill that longitudinal role.
If a lot of young people are using urgent care for their "urgent" needs, that could actually be a smart top-of-funnel opportunity to connect them with a primary care clinician. That's likely one reason health systems have launched their own urgent cares: to funnel patients into their primary care and specialty practices. But if you do a real root-cause analysis of the primary care problem, it comes down to supply. There simply aren't enough primary care physicians. We can try to incentivize more medical students to go into primary care, but that isn't happening. Opening up more slots for IMGs is another potential solution. Neither will close the gap fast enough—and we need it to happen now (more like yesterday).
So if we can't quickly scale the number of PCPs, the only realistic lever is helping existing PCPs do more with the same hours (which is what Tom, by Lumeris, is built for). Tom is an agentic AI. It continuously monitors a physician's entire patient panel, identifies the highest-impact next action for each patient, and then does proactive outreach, care gap closure, post-discharge follow-up, chronic disease management. It’s all autonomous and it can certainly help scale PCP panels.
This is all to say we'll need both solutions—increasing PCP supply and scaling agentic AI to expand panel capacity—to happen in parallel. But supply won't move fast enough on its own. The near-term answer is making what we have go further.
