ACOFP 2026 Health Policy
Advocacy Priority Number Three
Address the Family Physician Shortage
As more family physicians reach retirement age, the United States is facing shortages of 18,000 to 48,000 primary care physicians by 2034.[i] More needs to be done to address this shortage and increase the number of residents choosing family medicine.
Significantly higher reimbursement for specialists relative to primary care physicians contributes to the current imbalance between primary and specialty care. Primary care physicians are poorly compensated relative to their peers in specialty services, and medical students are financially incentivized to choose specialty training over primary care because of higher reimbursement for certain specialty medicine services, such as high-cost imaging, testing, and procedures.[ii] In AMGA's 2024 Medical Group Compensation and Productivity Survey[iii], medical groups and health care organizations reported a 5.6 percent increase in compensation for family medicine ($312,672 to $330,216). Comparatively, compensation for the top three medical specialties (cardiology, gastroenterology and hematology/oncology) increased 4.9 percent ($469,301 to $476,355). Despite encouraging trends, primary care physicians continue to earn considerably less than many of their medical colleagues, which is associated with the reduction in medical students choosing primary care careers and the shift of hospital graduate medical education (GME) priorities away from primary care.[iv] Compensation between primary care physicians and specialists remains a concern that policymakers must address to incentivize physicians to pursue primary care.[v]
Recent efforts to increase Medicare reimbursement for primary care, including through the calendar year (CY) 2026 Medicare Physician Fee Schedule (PFS) final rule, represent positive steps. Specifically, in the final rule, CMS implemented an efficiency adjustment that it estimates will result in an increase in work relative value units (RVUs) for specialties that more frequently bill timed codes, such as family medicine. However, a significant reimbursement differential still exists between primary care and specialty care, which neither reflects the inherent complexity of providing evaluation and management services nor the significant value these services provide to patients and to the Medicare program overall. Needed incentives for medical students to choose family medicine include:
- Equalizing reimbursement between various settings of care, i.e., office, outpatient clinic, emergency department, and eliminate the compensation imbalance between family and specialty medicine;
- Enhancing reimbursement by rewarding care that is proven to ensure high-quality patient outcomes and patient satisfaction; and,
- Providing financial support in the form of loans, loan forgiveness, and loan deferment.
In addition, more training opportunities are needed for medical students choosing family medicine, and medical education funding programs must be preserved and expanded, including Medicare GME, Teaching Health Center GME (THCGME), and Title VII.
However, ACOFP is concerned about recent federal actions that may impact medical students’ access to education and deter them from practicing in family medicine. The One Big Beautiful Bill Act (H.R. 1), signed into law on July 4, 2025, eliminated the Grad PLUS loan program beginning in the 2026-2027 academic year. This limits professional students, including medical students, to a $50,000 annual borrowing cap and a $200,000 lifetime cap for federal loans beginning in July 2026.[vi] ACOFP is concerned that this may pose disincentives for medical students to choose practicing family and osteopathic medicine and may prohibit diverse and low-income students from pursuing a career in medicine altogether.
Additionally, the Department of Education (ED) issued a final rule on October 31, 2025 that makes significant changes to the eligibility requirements to receive benefits from the Public Service Loan Forgiveness (PSLF) program to exclude individuals employed by organizations that “engage in activities that have a substantial illegal purpose”, which ED defined broadly to include providing gender-affirming care and engaging in diversity, equity, and inclusion policies, among other activities.[vii] ACOFP is concerned that this will reduce medical students’ access to loans and deter them from seeking employment at qualifying organizations, including nonprofit hospitals.
ACOFP is also concerned about the impact of recent federal actions that may impact the ability to grow the healthcare workforce and, thus, may worsen the family physician shortage. The Trump Administration imposed new requirements on H-1B nonimmigrant visas on September 19, 2025, including an increased application fee of $100,000 for new H-1B visa applications.[viii] ACOFP is concerned this increased fee will impact our nation’s ability to attract skilled and qualified health care workers, including physicians, which will exacerbate the family physician shortage and the U.S. health care workforce shortage overall.
Also, ACOFP is concerned about the use of non-compete clauses in employment contracts for physicians. These clauses limit or prevent the ability of employees to join or start a competing firm after separating from their jobs. As a result, physicians subject to a non-compete clause must either move geographic locations or stop practicing medicine, which only serves to exacerbate the family physician shortage. ACOFP supports ongoing efforts among federal and state policymakers to ban the use of non-compete clauses. Notably, the federal government previously sought to issue a rule against non-compete clauses, which was ultimately invalidated by the courts. In 2024, the Federal Trade Commission (FTC) announced a final rule banning non-compete clauses nationwide.[ix] The U.S. District Court for the Northern District of Texas, Dallas Division, and the U.S. District Court for the Middle District of Florida, Ocala Division, heard similar challenges to the rule, and both courts enjoined FTC from enforcing the rule.[x] In September 2025, FTC dismissed its appeals in these cases and acceded to the final rule being vacated.[xi] However, FTC has taken other steps to address non-compete clauses. In September 2025, FTC launched a public inquiry to understand the scope, prevalence, and effects of employer non-compete agreements and to gather information to inform future enforcement actions.[xii] Since September 2025, FTC has also pursued case-by-case enforcement actions ordering specific entities to halt the enforcement of their non-compete and no-hire agreements.[xiii]
Advocacy Positions:
- Support policies that eliminate the imbalance of reimbursement and compensation between primary care and specialty care.
- Reward care, through reimbursement policies, when provided by family medicine and proven to ensure high-quality patient outcomes and patient satisfaction.
- Expand access to loans for medical students and support deferment and forgiveness of loans for medical students who commit to specializing in primary care.
- Increase financial support to hospitals, especially those in rural areas, to establish residency programs in family medicine.
- Protect and expand medical education funding, including Medicare Direct and Indirect GME funding, and preserve existing alternative GME programs, such as the THCGME program and Title VII.
- Ensure that federal student loan programs are adequate for medical students pursuing careers in family and osteopathic medicine.
- Create exceptions to federal actions restricting visas for overseas physicians.
- Support efforts to ban the use of non-compete clauses for physician employment contracts.
[i] The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. Association of American Medical Colleges. June 2021. Accessed January 12, 2023. https://www.aamc.org/media/54681/download
[ii] Shi L. The impact of primary care: a focused review. Scientifica (Cairo). 2012;2012:432892. doi:10.6064/2012/432892
[iii] AMGA 2025 Medical Group Compensation and Productivity Survey. June 2025. Accessed January 25, 2026. https://www.amga.org/about-amga/newsroom/press-releases/2025/june/new-amga-survey-notes-significant-gains-in-physician-compensation
[iv] National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Committee on Implementing High-Quality Primary Care. Robinson SK, Meisnere M, Phillips RL Jr, McCauley L, eds. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. National Academies Press; 2021. doi:10.17226/25983
[v] Hsiang WR, Gross CP, Maroongroge S, Forman HP. Trends in compensation for primary care and specialist physicians after implementation of the Affordable Care Act. JAMA Netw Open. 2020;3(7):e2011981. doi:10.1001/jamanetworkopen.2020.11981
[vi] P.L. 119-21 (2025). More information on the law is available at https://www.congress.gov/bill/119th-congress/house-bill/1/text.
[vii] Department of Education, Final Rule, William D. Ford Federal Direct Loan (Direct Loan) Program. Published October 31, 2025. https://www.federalregister.gov/documents/2025/10/31/2025-19729/william-d-ford-federal-direct-loan-direct-loan-program.
[viii] Proclamation by President Donald Trump, Restriction on Entry of Certain Nonimmigrant Workers. Published September 19, 2025. https://www.whitehouse.gov/presidential-actions/2025/09/restriction-on-entry-of-certain-nonimmigrant-workers/.
[ix] Federal Trade Commission, Press Release, FTC Announces Rule Banning Noncompetes. Published April 23, 2024. https://www.ftc.gov/news-events/news/press-releases/2024/04/ftc-announces-rule-banning-noncompetes.
[x] Ryan LLC v. Federal Trade Commission, No. 3:2024cv00986 (N.D. Tex. 2024); Properties of the Villages, Inc. v. Federal Trade Commission, No. 5:2024cv00316 (M.D. Fla. 2024).
[xi] Federal Trade Commission, Press Release, Federal Trade Commission Files to Accede to Vacatur of Non-Compete Clause Rule. Published September 5, 2025. https://www.ftc.gov/news-events/news/press-releases/2025/09/federal-trade-commission-files-accede-vacatur-non-compete-clause-rule.
[xii] Federal Trade Commission, Press Release, Federal Trade Commission Issues Request for Information on Employee Noncompete Agreements. Published September 4, 2025. https://www.ftc.gov/news-events/news/press-releases/2025/09/federal-trade-commission-issues-request-information-employee-noncompete-agreements.
[xiii] See, e.g., Federal Trade Commission, Press Release, FTC Takes Action to Protect Workers from Noncompete Agreements. Published September 4, 2025. https://www.ftc.gov/news-events/news/press-releases/2025/09/ftc-takes-action-protect-workers-noncompete-agreements; and Federal Trade Commission, Press Release, FTC Continues Enforcement Action Streak Against Anticompetitive No-Hire Agreements. Published December 19, 2025. https://www.ftc.gov/news-events/news/press-releases/2025/12/ftc-continues-enforcement-action-streak-against-anticompetitive-no-hire-agreements.