Primary care is the foundation of California’s health care system and a critical driver of population health and equity. Yet access to timely, comprehensive primary care remains out of reach for millions of Californians.
Delivering all recommended care to an average patient panel would require a single primary care physician to work 26.7 hours per day, underscoring the need for care models that extend beyond physician-only care. More than 11.4 million Californians — over a quarter of the state’s population — live in federally designated Primary Care Health Professional Shortage Areas, and primary care receives just 5%–7% of total health care spending in California, well below international benchmarks.
Primary care teams offer a more sustainable and effective approach. By aligning care delivery with the skills of a broad range of health professionals, team-based primary care models improve access, quality, and workforce sustainability while better meeting the medical, behavioral, and social needs of patients and communities.
Key Findings
- Many Californians still can’t get the primary care they need, even though most people now have health insurance. Large parts of the state continue to face serious shortages of primary care providers.
- Primary care now includes far more than doctor visits, including prevention, chronic disease management, mental health, and help with social needs. Today’s care needs can’t be met well using traditional staffing models.
- Primary care teams include more roles than ever before, but California lacks reliable data on the full workforce, especially for medical assistants and community health workers.
- How primary care is paid for strongly affects how teams are staffed. Current payment models limit practices’ ability to hire for key roles such as nurses and pharmacists.
- Workforce shortages and inequities persist, particularly in rural and underserved communities and among licensed professionals who do not reflect California’s diversity.
- Training in primary care is limited and often siloed, leaving many graduates unprepared to work effectively in teams.
- Primary care practices need technical assistance to help them implement new care models, improve team functioning, and adopt new technologies.
Policy Recommendations
This report presents six recommendations for key decisionmakers:
- Improve workforce data.
Expand and standardize data collection for all members of the primary care team to support effective planning, accountability, and investment. - Bolster primary care payment.
Increase and restructure payment to support high-quality, team-based primary care and to ensure funding reaches frontline practices. - Address shortages and inequities.
Sustain and scale evidence-based strategies to address shortages, improve geographic distribution, and increase racial, ethnic, and linguistic diversity. - Expand interprofessional primary care education and training.
Require team-based primary care training across health professions programs so graduates are prepared to collaborate in primary care settings from day one. - Establish statewide technical assistance for practices.
Create a durable infrastructure to help practices build, sustain, and improve high-functioning primary care teams. - Support retention.
Reduce administrative burden, promote career pathways, and protect practice models that demonstrate strong team stability.
Moving Forward
To support sustained progress, the report recommends a coordinated implementation approach that includes monitoring access, equity, workforce capacity, and investment through a statewide primary care scorecard; aligning action across agencies and stakeholders via a cross-sector primary care task force; and establishing dedicated state-level leadership to reduce fragmentation and maintain long-term accountability for strengthening primary care.
