Primary care systems in the U.S. and other wealthy nations face similar challenges, including underfunding, workforce shortages and declining access to care. Expanding the primary care workforce through retraining and reentry offers a practical, near-term solution to strengthen care delivery and improve patient outcomes globally.
The United States’ primary care physician shortage is part of a broader epidemic being felt across the world’s richest nations.
An international study published in The Milbank Quarterly in February 2026 found that, despite different funding models, structures and policies, the same primary care issues are surfacing everywhere: workforce shortages, declining access and growing dissatisfaction among both patients and physicians.
For physicians considering their next career move, this broader context matters. It not only highlights the scale of the need but also reinforces that strengthening the primary care workforce — including through retraining and reentry — is central to the solution.
A Shared Problem Across Wealthy Nations
The study, titled “Sufficient and Efficient Spending on Primary Care Benefits National Health and Health Systems,” compares six high-income countries: the United States, United Kingdom, Canada, Australia, New Zealand and the Netherlands. While their healthcare systems differ significantly, their primary care challenges look strikingly similar.
Across all six countries:
- Primary care is underfunded relative to its role.
- The general practitioner (GP) workforce is shrinking or strained.
- Access to care is becoming more difficult.
- Burnout and administrative burden are rising.
- Fewer medical graduates are choosing primary care.
Even more telling: Most of these countries spend less than 6% of total healthcare dollars on primary care, despite overwhelming evidence that strong primary care improves outcomes and lowers overall costs.
Where the U.S. Stands
Primary care accounts for less than 5% of total healthcare spending in the U.S., even though it represents more than one-third of all healthcare visits.
The consequences are clear:
- Nearly one-third of Americans lack a primary care clinician.
- Burnout affects roughly 40% of family physicians.
- Payment models continue to favor specialists and procedures over longitudinal care.
Unlike countries with national health strategies, the U.S. also lacks a coordinated, system-wide plan to rebuild primary care, making workforce challenges even harder to address.
How Other Countries Compare
While the U.S. faces acute challenges, other wealthy nations are grappling with many of the same pressures, often with different trade-offs.
- United Kingdom: Once considered a model, the UK’s system is now under strain, with patient satisfaction dropping sharply. Despite expanded training programs, the number of full-time GPs has stagnated due to burnout and workload pressures.
- Canada: More than one in five Canadians lacks a regular primary care provider, driven by retirements, burnout and physicians shifting away from traditional family practice.
- Australia and New Zealand: Both countries are seeing declining interest in primary care careers, rising patient costs and growing access issues, particularly in rural areas.
- Netherlands: Often held up as a best-in-class system, the Netherlands still faces a looming workforce shortage, with 30% of GPs expected to retire within six years.
Across all these systems, the pattern is the same: even well-designed healthcare models cannot function without a strong, supported primary care workforce.
The Core Issue: Workforce, Not Just Funding
While underfunding is a common thread, the study emphasizes a deeper issue: a shrinking and unsustainable primary care workforce.
Several factors are driving this trend globally:
- Aging physician populations nearing retirement
- Fewer new physicians choosing primary care
- Increasing administrative burden and complexity
- Growing demand from aging populations with chronic conditions
Importantly, simply increasing training slots is not enough. Countries that have tried this approach in isolation have seen limited success because it does not address the underlying issues of career attractiveness, workload and support.
What the Research Says About Solutions
Despite different systems, the study identifies a shared set of solutions that apply across countries:
1. Increase and Rebalance Investment: Experts suggest targeting 10% to 15% of healthcare spending toward primary care to better reflect its foundational role.
2. Build Team-Based Models: Primary care is increasingly delivered by multidisciplinary teams, including nurses, pharmacists and social workers, to improve access and reduce physician burden.
3. Strengthen Workforce Pipelines: This includes not just training new physicians, but also retraining and re-engaging experienced clinicians.
4. Align Policy and Practice: Fragmented policies and incentives often undermine primary care. A coordinated, system-wide approach is essential.
Where Physician Retraining and Reentry Fit In
One of the most overlooked and immediately actionable solutions is expanding the primary care workforce by bringing experienced, licensed physicians into the primary care field through retraining and reentry.
This approach directly addresses several of the challenges identified in the study:
- It expands the workforce faster.
- Training new physicians takes years; retraining experienced physicians can significantly shorten that timeline.
- It brings clinical maturity into primary care.
- Physicians who retrain often bring years of specialty experience, improving decision-making and patient care.
- It helps stabilize access in underserved areas.
- Retrained physicians are well-positioned to step into communities with immediate need, including rural and high-demand regions.
- It supports sustainable career paths.
- For physicians experiencing burnout or dissatisfaction in their current roles, primary care can offer a more meaningful, relationship-driven practice model.
In a global environment where fewer medical graduates are choosing primary care, retraining is not just a career option, it’s a workforce strategy.
A Global Problem, A Practical Opportunity
The takeaway from this international comparison is clear: no healthcare system is immune to primary care challenges.
Countries that succeed will be those that:
- Invest meaningfully in primary care.
- Support team-based, sustainable practice models.
- Expand and strengthen the workforce through both traditional and nontraditional pathways.
For physicians considering a change, this moment represents more than a career pivot. It’s an opportunity to step into one of the most important and urgently needed roles in healthcare.
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