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More than 80% of primary care physicians are concerned about their long-term financial sustainability, underscoring growing economic pressure across independent practices, according to an Elation Health survey of 280 clinicians.
The study found reimbursement remains the most significant pressure point: 64% of respondents cited reimbursement as their top financial challenge.
Kyna Fong, CEO and co-founder of Elation Health, told Healthcare Finance News the core issue is a structural mismatch between what it takes to run a primary care practice, versus what the system pays for it.
This challenge is leading many physicians to actively pursue new approaches to stabilize their practices. Among insurance-participating physicians, 27% have adopted membership or cash-pay models, while 18% are shifting toward value-based payment structures.
While other payment models are viable, the model itself isn’t what determines success – execution does, Fong said.
"We see practices operating under membership, cash-pay, value-based arrangements, and hybrid models," she said. "Some are thriving; others are struggling. The difference is whether they have the infrastructure to support the model effectively."
Practices need three things to succeed: technology that’s purpose-built for their payment model, integration with the broader healthcare system and predictable cash flow.
"Without that foundation, even the best-designed models create operational strain," Fong said.
Technology is playing a growing role, with 58% of physicians calling AI "essential" to the future of primary care, and about half are already using AI tools. Among those users, 78% reported positive impacts, including reduced documentation time and lower levels of burnout.
Fong agreed AI is a transformational technology but added its impact depends entirely on how it's applied.
"Translating AI into real value delivered to the front lines of care is still the most important challenge," she said.
Overall, 69% of respondents said they are developing plans to address financial concerns, with most changes expected to take effect within two years.
Financial stability emerged as the top concern overall, followed closely by work-life balance, reflecting the dual pressure of maintaining both operational viability and clinician wellbeing.
Additional constraints, including staffing, technology costs and overhead, are further limiting investment in patient care and shaping how practices prioritize resources.
Although primary care delivers one of the highest returns in healthcare, the U.S. invests only 5%-7% of healthcare spend in primary care, compared with about 14% in other developed countries, Fong noted.
"That underinvestment shows up directly in reimbursement," Fong said.
The findings also point to continued engagement among clinicians. Eighty percent of respondents reported feeling joy in their work, at least weekly, and 93% said they remain committed to primary care despite ongoing financial concerns.
Burnout isn't caused by the practice of medicine but is caused by the cognitive weight of everything around it, Fong said. This includes task overload, the constant context switching and the mental burden of tracking administrative work are what wear clinicians down.
"The most meaningful role for AI is to remove that cognitive load," Fong said. "It should automate routine, rules-based work – documentation, coding, follow-ups – so clinicians and staff can focus on patients."
Email the writer: SMorse@himss.org