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A new analysis of fee-for-service Medicare claims shows a sharper rise in primary care physicians leaving the federal health program than in specialists, raising concerns about older adults’ access to care.

An estimated 4.4% of primary care physicians enrolled in Medicare left the program in 2023, up from 3.3% in 2014, according to researchers Hannah T. Neprash, PhD, of the University of Minnesota, Minneapolis, and Michael E. Chernew, PhD, of Harvard Medical School, Boston, writing in JAMA Health Forum.

By comparison, the share of physicians in surgical specialties who exited Medicare rose from 2.3% to 3.0% over the same period. Exit for hospital-based specialties held steady at 3.5%, while those for other medical specialties remained at 2.5%. (There were temporary spikes across all specialties in 2020 and 2021, likely due to the COVID-19 pandemic, but these subsided.)

Neprash and Chernew analyzed Medicare Part B claims from 2010 to 2024 for services provided by physicians. To avoid conflating permanent exits with sporadic billing, they excluded physicians who averaged fewer than 100 Medicare claims annually.

Possible reasons for the exits include the greater burden of new communication methods like online messaging and demands for clinical documentation, the authors noted.

Neprash also told Medscape Medical News that some of the apparent exits from traditional Medicare may reflect a shift to caring primarily for patients enrolled in Medicare Advantage plans.

The study’s limitations include its reliance on Medicare fee-for-service claims, which does not capture physician participation in Medicare Advantage. The analysis also does not distinguish between physicians who left Medicare and those who retired or exited clinical practice. Physician entry was also not accounted for, so changes in the overall physician workforce could not be fully assessed.

Still, the research raises important concerns about the future supply of primary care clinicians. “This research opens more questions than it answers,” Neprash said.

Physician Fee Schedule Shakeup?

The Medicare Payment Advisory Commission (MedPAC) has repeatedly urged rebalancing Medicare’s payment rates, arguing that current models undervalue the work of primary care physicians compared with specialists.

“Compensation remained much lower for primary care physicians ($296,000) than for most specialists in 2023 (eg, $496,000 for surgical specialties) — a disparity that may help explain why the share of physicians pursuing primary care in the US has been declining,” MedPAC noted in its March 2025 Report to Congress.

Direct Primary Care and Medicare Participation

Despite these challenges, Medicare beneficiaries may still have more stable access to primary care clinicians than younger populations.

MedPAC in its March report cited a 2024 survey showing that 11% of people enrolled in Medicare were searching for new primary care clinicians compared with 16% of individuals covered by private insurance. Among those searching, 52% of Medicare beneficiaries reported difficulty finding a new provider compared with 66% of those with private insurance.

Interest in concierge medicine as well as direct primary care has been rising. These practices generally forgo insurance billing, instead charging patients set monthly or annual fees for access to services — offering both administrative simplicity for clinicians and price transparency for patients.

Some of the physician exits from Medicare reported by Neprash and Chernew may reflect growing participation in direct primary care.

Patients enrolled in Medicare can still see physicians in direct primary care practices as long as they are willing to pay the membership fees out of pocket. Physicians in direct primary care can continue to order tests, make referrals, and write prescriptions covered by Medicare — as long as they remain registered in the Provider Enrollment, Chain, and Ownership System (PECOS).

“As long as the physician keeps their PECOS number active, then Medicare will honor their orders, as long as they’re a licensed practicing physician,” said Jeffrey Davenport, MD, president of the Direct Primary Care Alliance and a direct primary care physician in Edmond, Oklahoma.

Physicians who formally opt out of Medicare face a 2-year wait period before they can re-enroll.

Davenport transitioned to direct primary care in 2012, citing the appeal of a membership model and lower overhead costs.

Davenport called the shift a “win” for both himself and his patients. He now handles minor procedures like stitches during office visits, sparing patients unnecessary emergency room trips. He also takes on fewer patients and spends more time with them during office visits.

“The patients love the service and love the ability to create a rapport and get to know their doctor,” Davenport said. “My life is better. I have more time to take care of the patients.”

Neprash reported receiving grants from Arnold Ventures during the conduct of the study. Chernew reported receiving grants from Arnold Ventures during the conduct of the study; receiving personal fees from LRVHealth, VBID Health, Waymark, Inc., and MITRE outside the submitted work; and serving on the Blue Cross Blue Shield Association Advisory Board, Blue Health Intelligence Advisory Board, Health Care Cost Institute Board, National Institute for Health Care Management Advisory Board, Congressional Budget Office’s Panel of Health Advisers, Massachusetts Health Connector, MedPAC, and Aledade Advisory Council outside the submitted work.

Davenport reported having no financial relationships.

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has covered medical research and healthcare policy for more than 20 years.