The TV trope of a sole practitioner treating one family’s infants and great-grandparents over decades hasn’t felt realistic for years — fewer and fewer physicians practice that way. But a new Dutch study of more than 100,000 patients provides a clear reminder of what continuous primary care can accomplish.

People registered with the same general practice for more than 5 years had up to 21% lower costs for urgent hospital admissions and up to 39% lower overall hospital costs. The longer the relationship, the greater the gain.

In Netherlands, long-term primary care is the norm, and health insurance is mandatory and heavily regulated. Not so in the US, but the core principle holds: When a clinician or care team knows a patient’s baseline, they make faster, more confident decisions. That means fewer tests and referrals, timelier course corrections, and a better chance of keeping manageable problems out of the emergency room.

“We’ve let folks come to think that volume-level access trumps all things. I think what you’re seeing in this Dutch article, it just doesn’t,” said Andrew Bazemore, MD, MPH, primary care physician in Fairfax, Virginia, and senior vice president of research and policy for the American Board of Family Medicine. He coauthored a 2023 critical review of continuity-of-care research that found continuity led to significant reductions in measures such as costs and hospitalizations in 109 of 160 outcomes.

How Continuity Changes Care

Long-term relationships yield insights that can’t always be captured in an electronic chart — such as a patient’s demeanor, medication adherence habits, social support networks, and what has or hasn’t worked before.

“Someone who doesn’t know you will be focused on the problem you’re identifying and how to solve it. It’s a deficit orientation, something wrong and how to fix it,” said Rebecca Etz, PhD, co-director of the Larry A. Green Center in Richmond, Virginia. “Someone who knows you understands what you’ve got going for you. They’d know more about your habits that could be supportive of helping you, your social assets to draw on.”

Maintaining that level of continuity is difficult in the US system. A recent Milbank Memorial Fund analysis found that less than 5% of US healthcare spending went to primary care in 2022 (other high-income countries spend almost three times as much), and nearly one third of adults lacked a regular source of primary care altogether. Meanwhile, the 2026 physician compensation report from Doximity found that primary care physicians earn 90% less than surgical specialists. This lack of compensation likely contributes to the primary care physician shortage, which in turn makes continuity that much more challenging.

Insurance disruptions further complicate matters. Ripley Hollister, MD, who has practiced family medicine in Colorado for 35 years, still treats multiple generations of the same family — yet keeping those relationships uninterrupted remains a constant hurdle. “People change employers. Employers have different insurance companies. Insurance companies have different panels,” he said. “I have patients that have literally gone in and out of my practice three, four times over their lifespan.”

A Crucial Step: Measure Continuity

The challenge is designing workflows that preserve accumulated knowledge within a system built largely to work against it. More than half of all US physicians are employed by hospitals or health systems, where patient portals and centralized call centers slot patients into whichever appointment is available first. High-volume access takes priority. For an individual clinician, shifting a health system’s focus can feel like a tall order, but primary care experts insist it’s achievable.

“It is possible to care about both access and continuity at the same time. It is simply a choice that your health system has to make,” Etz said. 

While health systems routinely track volume, blood pressure control, and quality metrics, few regularly measure how often patients see their primary clinician or assigned care team.

“If you don’t name it and say we are going to measure and value it, the rest doesn’t matter,” Bazemore said. “That is not the only thing, but without that, I don’t think you’re going to get very far.”

The evidence favoring continuity is clear — and actionable for those with a seat at the table. “If you’re sitting in a committee or a leadership position in a primary care service line, you can encourage your hospital to make sure that while access is important, we’re going to reward matching the patient to the clinician or team,” Bazemore said.

Other Ways to Boost Continuity

Several other strategies can help strengthen patient continuity. Moving to a team-based model is one effective approach. Grouping physicians, nurses, physician assistants, and care managers into dedicated pods expands the roster of familiar faces for each patient. Team members share notes and updates, allowing any one of them to step in seamlessly when a patient's primary clinician is unavailable.

Bazemore’s own practice is owned by a hospital system, but he and his colleagues built continuity into the workflow. They worked with information technology and central scheduling to prioritize matching patients with their primary physician or immediate care team — and they reserve dedicated slots in each clinician’s schedule for urgent, same-day visits. 

Clifford Bowers, DO, family medicine physician at Sandhills Medical — a Federally Qualified Health Center serving roughly 12,000 predominantly uninsured or Medicaid-covered patients in rural South Carolina — uses risk-stratified scheduling.

For instance, the appointment frequency for patients with diabetes depends on their A1c control. If an A1c is below 8%, “you get to go away for 6 months. I’ll see you twice a year, if you’re controlled. If your A1c is above eight, we’re going to make some changes, and we’ll see you in 3 months,” he said. “I’m not clogging up my office with people who are well controlled.”

Telehealth also extends continuity without filling clinic schedules. For high-risk patients managing conditions such as diabetes or hypertension, virtual visits keep team members connected between annual visits. As Bazemore explained, these touchpoints engage patients “when we don’t need a physical exam.”

Show Them the Money

Real, lasting change requires investment — no one expects physicians to shoulder the burden of redesigning primary care without institutional support. Yet when health systems commit to the effort, aligning schedules to establish patient-clinician relationships is surprisingly achievable.

“An improvement investment in primary care means that you pay up front for silver, and then at the end you get the gold,” Hollister said. “You make an investment in inexpensive care that’s more thorough and continuous, and in the end, you prevent very expensive emergency room care procedures.”

The experts cited in this article reported having no relevant disclosures.